Geneva Score (Revised) for Pulmonary Embolism

• For patients identified as "low-risk,” clinicians may consider applying the PERC (Pulmonary Embolism Rule-out Criteria) Rule. 
• For patients over the age of 50 who are classified as "low risk" or "intermediate risk" (Revised Geneva score <11), use an age-adjusted D-dimer cutoff to increase specificity.

1. Clinical suspicion of PE:  Apply score only if PE is reasonably suspected based on history and exam.

2. Assess pre-test probability: Apply revised Geneva Score.

3. Risk assessment:

• If low risk, consider additional tools such as PERC to confirm.

• If intermediate risk, consider D-dimer testing.

• If high-risk, consider proceeding directly to CTPA.

Be familiar with any best practice pathways your institution may follow.

• Never delay resuscitation for diagnostic testing in unstable patients.
• Always obtain a history and physical exam before applying clinical decision rules.
• Clinical gestalt trumps decision making rules.