MDCalc

Bova Score for Pulmonary Embolism Complications

Predicts 30-day risk of PE-related complications in hemodynamically stable patients.

Requires diagnostic confirmation of pulmonary embolism (e.g., CT pulmonary angiography or V/Q scan) plus assessment of right ventricular dysfunction (e.g., transthoracic echocardiography or CT) and cardiac biomarkers (e.g., troponin).

Do not use in patients who are hemodynamically unstable or without confirmed PE.

Systolic BP
If sBP <90, patient not eligible for Bova scoring
Elevated cardiac troponin
Standard assay and lab cutoff value
RV dysfunction
On TTE: RV/LV ratio >0.9, sPAP >30, RV end diastolic diameter >30mm, RV dilation, or free wall hypokinesis; on CT: RV/LV ratio >1 (short axis diameter)
Heart rate, beats/min

Result:

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Advice
  • This tool should not be the sole determinant in managing acute PE; it provides structured risk assessment to inform, not dictate, clinical decisions.
  • High-risk patients (score >4) should be monitored closely, with a plan for escalation (e.g., thrombolysis, advanced hemodynamic support, multidisciplinary consultation) if clinical deterioration occurs.
  • Intermediate-risk patients may also benefit from closer observation or escalation of care, while low-risk patients can typically be managed with anticoagulation alone. 
  • Always consider additional clinical findings and patient preferences when applying the score.
Management
  • Low risk (score ≤2): 
    • Proceed with standard anticoagulation therapy.
    • Standard outpatient or inpatient monitoring, as appropriate.
  • Intermediate risk (score 3–4): 
    • Consider closer monitoring (e.g., stepdown/ICU).
    • Discuss the possibility of advanced therapies (e.g., thrombolysis) in select cases, especially if clinical status worsens. 
  • High risk (score >4): 
    • Maintain continuous ICU monitoring with a clear plan for rapid intervention if clinical status worsens (e.g., hypotension, worsening hypoxia, arrhythmias).
    • Strongly consider multidisciplinary team involvement and potential advanced therapies (e.g., systemic thrombolysis or catheter-directed therapies).

Refer to relevant clinical guidelines (e.g., ESC, ACCP) for detailed management recommendations.

Critical Actions
  • Do not rely solely on the Bova Score; incorporate additional markers (e.g., respiratory rate, oxygen saturation, lactate, syncope) and comorbidities when assessing overall risk. 
  • Be prepared to intervene promptly if the patient’s clinical status changes, including holding or reversing anticoagulation if significant bleeding occurs. 
  • This tool does not account for the risks of therapeutic interventions; individualize therapy based on overall clinical context and patient preferences. 
  • Ensure multidisciplinary input for high-risk patients to optimize outcomes and minimize risks.
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