For healthcare professionals
Bova score calculator
The Bova score adds points for low-normal blood pressure, a raised cardiac troponin, right ventricular dysfunction and a fast heart rate in adults with confirmed pulmonary embolism (PE) whose blood pressure is not low. It sorts them into stages I to III. This tool is written for clinicians and is not a diagnosis.
Patient details
For adults with confirmed acute PE and a systolic blood pressure of 90 mmHg or more. Nothing you enter leaves this page.
What you will see
The total Bova score from 0 to 7, its stage and the points for each item, with the published 30-day complication rate for that stage.
Educational only, not medical advice. A score does not replace clinical judgment.
Source
The Bova score by Bova and colleagues, European Respiratory Journal 2014 (cited, not quoted), with the points and stages as printed in section 2.4.2 of Efeoglu Sacak and Kudu, Diagnostics 2026 (CC BY 4.0), and cross-checked against the review by Machanahalli Balakrishna and colleagues, Medicina 2022 (CC BY). The 30-day rates by stage are printed in that review and in Leidi and colleagues, Journal of Clinical Medicine 2022 (CC BY 4.0). The tests check each item, the maximum of 7, the stage edges and the blood pressure and heart rate edges.
Validated in
Normotensive adults (systolic blood pressure 90 mmHg or more) with confirmed acute symptomatic PE. Leidi and colleagues describe the derivation data as pooled results of 6 prospective studies including 2,874 patients with hemodynamically stable acute PE. Efeoglu Sacak and Kudu tested it in 383 normotensive patients with PE confirmed on CT pulmonary angiography at one center in Istanbul (median age 72).
Limits
Not for people with a systolic blood pressure under 90 mmHg: they have high-risk PE and the score does not apply. Troponin and right ventricular dysfunction are entered as yes or no; the cutoffs and imaging method follow local practice and differed between studies. Stage III is uncommon (5.8% of patients in the derivation data and 5.7% in the Istanbul cohort), so most patients land in stages I and II. The score sorts risk; it does not decide treatment on its own. A systolic of 90 and 100 mmHg counts; 101 does not. A heart rate of 110 counts; 109 does not.
The point table
Bova score, as printed in Efeoglu Sacak and Kudu 2026, section 2.4.2 (Efeoglu Sacak 2026), with the same points and stages in Machanahalli Balakrishna and colleagues 2022 (Machanahalli Balakrishna 2022) (Bova 2014):
- Systolic blood pressure 90 to 100 mmHg: 2
- Elevated cardiac troponin: 2
- Right ventricular dysfunction: 2
- Heart rate 110 per minute or higher: 1
The maximum is 7. Leidi and colleagues print the derivation definition of right ventricular dysfunction as an RV/LV ratio above 0.9 or 1, RV free wall hypokinesis, an RV end-diastolic diameter above 30 mm or an estimated systolic pulmonary artery pressure above 30 mmHg, and the outcome as PE-related death, hemodynamic collapse or recurrent PE at 30 days (Leidi 2022). The review by Machanahalli Balakrishna and colleagues describes the blood pressure item as a systolic of 90 to 100 mmHg for at least 15 minutes (Machanahalli Balakrishna 2022).
Worked example: a systolic of 98 mmHg (2), a heart rate of 112 (1), a raised troponin (2) and right ventricular dysfunction (2) give 7 points, stage III.
Stages and 30-day rates
Stage I is 0 to 2 points, stage II is 3 to 4 points and stage III is more than 4 points (5 to 7) (Efeoglu Sacak 2026) (Machanahalli Balakrishna 2022).
In the original study, PE-related complications within 30 days occurred in 4.2% of patients in stage I, 10.8% in stage II and 29.2% in stage III. Both open texts print these rates (Machanahalli Balakrishna 2022) (Leidi 2022). The review by Machanahalli Balakrishna and colleagues adds 30-day PE-related mortality of 1.7%, 5.0% and 15.5% by stage (Machanahalli Balakrishna 2022). Leidi and colleagues report an area under the ROC curve of 0.73 (95% CI 0.68 to 0.77) in the derivation study, with 5.8% of patients in stage III (Leidi 2022).
A meta-analysis of the derivation study and 8 validation cohorts found lower rates in stage III: pooled 30-day PE-related complications (death, hemodynamic collapse or recurrent PE) of 3.8% in stage I, 10.8% in stage II and 19.9% in stage III, as summarized by Leidi and colleagues (Leidi 2022).
Reading the result
In 383 normotensive patients at one center in Istanbul, 56 (14.6%) had a complicated 30-day course (death, hemodynamic collapse, cardiac arrest, mechanical ventilation or rescue reperfusion). The Bova score had an AUC of 0.663 (95% CI 0.587 to 0.740). Stage III covered 22 patients (5.7%), with a specificity of 95.7% and a sensitivity of 14.3% (Efeoglu Sacak 2026). In other words, a stage III result points to high risk, but most patients who later deteriorated were in stages I and II.
General safety advice (not part of the score): a falling blood pressure, fainting, worsening breathlessness or new confusion needs urgent review whatever the stage.
Related tools
To estimate 30-day mortality after a confirmed PE, see the PESI score calculator. For 11 yes/no questions on treatment at home, see the Hestia criteria. Before the diagnosis, see the Wells score for PE and the revised Geneva score. Other bedside scores are listed under For healthcare professionals.
Sources
- Efeoglu Sacak M, Kudu E. Prediction of 30-day complicated clinical course in acute pulmonary embolism: a prospective cohort comparison of the ESC, Bova, and modified FAST models. Diagnostics (Basel). 2026;16(18):2991. doi:10.3390/diagnostics16182991. PMID 42793776. Open access (CC BY 4.0). Section 2.4.2 (Bova points and stages), sections 3.4 and 3.5 (stage III share, AUC). pmc.ncbi.nlm.nih.gov/articles/PMC13605380/
- Machanahalli Balakrishna A, Reddi V, Belford PM, Alvarez M, Jaber WA, Zhao DX, Vallabhajosyula S. Intermediate-risk pulmonary embolism: a review of contemporary diagnosis, risk stratification and management. Medicina (Kaunas). 2022;58(9):1186. doi:10.3390/medicina58091186. PMID 36143863. Open access (CC BY). Bova score paragraph (points, stages and the 30-day rates of the original paper). pmc.ncbi.nlm.nih.gov/articles/PMC9504600/
- Leidi A, Bex S, Righini M, Berner A, Grosgurin O, Marti C. Risk stratification in patients with acute pulmonary embolism: current evidence and perspectives. J Clin Med. 2022;11(9):2533. doi:10.3390/jcm11092533. PMID 35566658. Open access (CC BY 4.0). Bova score paragraph (pooled 30-day rates by stage). pmc.ncbi.nlm.nih.gov/articles/PMC9104204/
- Bova C, Sanchez O, Prandoni P, Lankeit M, Konstantinides S, Vanni S, Jimenez D. Identification of intermediate-risk patients with acute symptomatic pulmonary embolism. Eur Respir J. 2014;44(3):694-703. doi:10.1183/09031936.00006114. Original paper, cited, not quoted. doi.org/10.1183/09031936.00006114
Written and maintained by the uncovermyrisk.com editorial team. We do not have a medical reviewer; every claim links to its primary source above. Last reviewed: 2026-11-03. Spotted an error? See About.