Score the likelihood of a pulmonary embolism or an arm DVT, and see when to call 911 or refer the same day.
Two clot-screening scores the 2022 APTA venous thromboembolism guideline asks physical therapists to use. The simplified revised Geneva score estimates how likely a pulmonary embolism (PE) is when a patient has new shortness of breath, chest pain, fainting or coughs up blood. The Constans score estimates how likely a deep vein thrombosis (DVT) in the arm is. For a swollen, painful leg, use the Wells Criteria for DVT instead.
Call 911 for sudden or severe shortness of breath, chest pain, coughing up blood or fainting. Don’t leave the patient alone and don’t wait to finish a score. If you’re a patient worried about a swollen, painful arm or leg, call your doctor today.
Use when a patient has dyspnea, chest pain, presyncope or syncope, or hemoptysis (APTA VTE guideline, Action Statement 7). Check each finding that is present.
Use when a patient has arm swelling, pain, edema, cyanosis or dilated superficial veins (APTA VTE guideline, Action Statement 6). Check each finding that is present.
These scores support clinical judgment. They are not a diagnosis. A low or “unlikely” score does not rule out a clot without testing, and a high or “likely” score needs medical work-up. Use them only when a clot is a real concern, after a history and exam.
| Simplified revised Geneva | Probability | PE found (Klok 2008) |
|---|---|---|
| 0 to 1 | Low | 7.7% |
| 2 to 4 | Intermediate | 29.4% |
| 5 or more | High | 64.3% |
| 0 to 2 | PE unlikely (two-level) | 12.9% |
| 3 or more | PE likely (two-level) | 41.6% |
The tool also shows the original weighted revised Geneva score (Le Gal 2006: age over 65 = 1, previous DVT/PE = 3, surgery or fracture within 1 month = 2, active cancer = 2, one-sided leg pain = 3, hemoptysis = 2, heart rate 75–94 = 3 or 95 or more = 5, deep-vein palpation pain with one-sided edema = 4). Original cut-offs: 0–3 low, 4–10 intermediate, 11 or more high.
| Constans score | APTA guideline (two-level) | Constans 2008 (three-level) |
|---|---|---|
| −1 or 0 | Arm DVT unlikely | Low probability |
| 1 | Arm DVT unlikely | Intermediate probability |
| 2 or 3 | Arm DVT likely | High probability |
Sources. Klok FA, Mos ICM, Nijkeuter M, et al. Simplification of the revised Geneva score for assessing clinical probability of pulmonary embolism. Arch Intern Med. 2008;168(19):2131-2136. doi:10.1001/archinte.168.19.2131 (full text). Le Gal G, Righini M, Roy PM, et al. Prediction of pulmonary embolism in the emergency department: the revised Geneva score. Ann Intern Med. 2006;144(3):165-171. doi:10.7326/0003-4819-144-3-200602070-00004. Constans J, Salmi LR, Sevestre-Pietri MA, et al. A clinical prediction score for upper extremity deep venous thrombosis. Thromb Haemost. 2008;99(1):202-207. doi:10.1160/TH07-08-0485. Kleinjan A, Di Nisio M, Beyer-Westendorf J, et al. Safety and feasibility of a diagnostic algorithm combining clinical probability, d-dimer testing, and ultrasonography for suspected upper extremity deep venous thrombosis. Ann Intern Med. 2014;160(7):451-457. doi:10.7326/M13-2056. Hillegass E, Lukaszewicz K, Puthoff M. Role of physical therapists in the management of individuals at risk for or diagnosed with venous thromboembolism: evidence-based clinical practice guideline 2022. Phys Ther. 2022;102(8):pzac057. doi:10.1093/ptj/pzac057 (APTA Academies of Cardiovascular & Pulmonary PT and Acute Care; Action Statement 7, evidence level I, grade A: assess PE likelihood, revised Geneva score recommended; Action Statement 6, evidence level II, grade B: assess arm DVT likelihood with the Constans criteria and D-dimer; full text).
Permissions. Published clinical prediction rules (a list of findings with point values). This page restates the findings and cut-offs in its own words with full citation and does not reproduce the journals’ tables; the APTA guideline itself points clinicians to online calculator versions. Holsman Physical Therapy is not affiliated with these authors, journals or the APTA, and they do not endorse this website.
Clinically reviewed by Dr. Richard Holsman, PT, DPT, NCS. Last reviewed: November 12, 2026.
Next step: When a clot is suspected, the patient needs medical evaluation before therapy continues. Once a clot is ruled out or treated, Holsman physical therapists see patients at clinics across North Jersey, the Bronx and Brooklyn, plus in-home visits. Refer a patient or call 1-855-465-7626.
The revised Geneva score estimates how likely a pulmonary embolism (PE) is from 8 objective findings, such as age, heart rate, prior clots and leg signs. It was published by Le Gal and colleagues in 2006. In 2008 Klok and colleagues showed a simplified version, with 1 point per item, works as well.
Each item scores 1 point, except heart rate: 75 to 94 beats per minute scores 1 and 95 or more scores 2. Three-level: 0 to 1 low, 2 to 4 intermediate, 5 or more high clinical probability. Two-level: 0 to 2 PE unlikely, 3 or more PE likely.
The Constans score estimates how likely a deep vein thrombosis (DVT) in the arm is. It has 4 items: venous material such as a central venous catheter or pacemaker (+1), localized pain (+1), unilateral pitting edema (+1) and another diagnosis at least as plausible (-1). In the APTA guideline, 1 or less means arm DVT unlikely and 2 or more means likely.
The 2022 APTA venous thromboembolism guideline (Action Statement 7) recommends the revised Geneva score because, unlike the Wells PE rule, it has no subjective item about whether another diagnosis is more likely.
These scores support clinical judgment and never rule a clot in or out by themselves. A patient with new signs of PE needs medical evaluation that day whatever the score, and 911 for sudden or severe shortness of breath, chest pain, coughing up blood or fainting. For a suspected arm DVT, hold exercise of that arm and contact the medical team: an unlikely score is followed by a D-dimer test, a likely score by ultrasound before mobility continues.
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Holsman physical therapists see patients at clinics across North Jersey, the Bronx and Brooklyn, plus in-home visits.
📞 Call 1-855-465-7626