This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.
Pulmonary embolism (PE) ranges from a small clot that can be treated at home to a massive clot that causes shock. For the large middle group, patients whose blood pressure is normal, doctors need to know who might still deteriorate. The Bova score, published by Carlo Bova and colleagues in 2014 from a pooled analysis of about 2,900 patients, predicts PE-related complications within 30 days.
The score
| Criterion | Points |
|---|---|
| Systolic blood pressure 90 to 100 mmHg | 2 |
| Elevated cardiac troponin | 2 |
| Right ventricular dysfunction (echocardiography or CT) | 2 |
| Heart rate 110 bpm or more | 1 |
The total ranges from 0 to 7.
Example
A patient with a normal blood pressure, a raised troponin, no right ventricular dysfunction on CT and a heart rate of 115 scores 2 + 1 = 3: stage II.
Interpretation
| Stage | Score | PE-related complications at 30 days |
|---|---|---|
| I | 0 to 2 | about 4% |
| II | 3 to 4 | about 11% |
| III | above 4 | about 29% |
Complications in the derivation study meant death from PE, hemodynamic collapse or recurrent PE. PE-related death rose from about 3% in stage I to about 15% in stage III.
How it is used
The Bova score is applied after a patient is classed as not low risk, for example with the simplified PESI. Stage III patients are the “intermediate-high” group, who may need monitoring in an intensive or step-down unit and who are candidates for rescue reperfusion treatment if they worsen. The European Society of Cardiology guideline uses a closely related approach that combines troponin and right ventricular dysfunction.
Limits
- The score applies only to patients without shock (systolic pressure of 90 mmHg or more).
- Troponin assays and cut-offs vary between hospitals.
- It estimates risk; treatment decisions remain with the clinical team.