Bova Score Calculator for Pulmonary Embolism
Calculate original Bova points and stage in normotensive confirmed acute PE from systolic pressure, heart rate, assay-classified troponin and documented RV dysfunction.
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About
The Bova score calculator applies the original 2014 seven-point index after acute symptomatic pulmonary embolism is confirmed and the normotensive assessment context is established. It estimates source-defined risk strata for 30-day PE-related complications: PE-related death, hemodynamic collapse or recurrent PE. It is not a diagnostic rule, an all-cause-mortality-only model, or an outpatient eligibility test. The development analysis pooled 2,874 normotensive patients from six prospective PE studies. [1]
Only four predictors contribute: systolic pressure 90–100 mmHg (+2), elevated cardiac troponin (+2), documented RV dysfunction (+2), and heart rate ≥110 beats/min (+1). This is not modified Bova, lactate-augmented Bova, FAST, TELOS or CPES. [1, 3]
Formula
Interpretation
Original stage and current-guideline component are separate
| Bova total | Original 2014 stage | 2026 AHA/ACC clinical-severity score component |
|---|---|---|
| 0–2 | Stage I | Low |
| 3–4 | Stage II | Low |
| 5–7 | Stage III | Elevated |
Stage II is not “AHA elevated”: totals 3–4 remain Stage II in the original Bova model and Low in the separate 2026 severity-score component. Bova alone does not determine AHA/ACC category A–E, C1–C3 or a respiratory R modifier. [1, 3]
Historical 2014 cohort outcomes
These are historical cohort observations, not your complication probability or an individual mortality estimate. The complication composite is PE-related death, hemodynamic collapse or recurrent PE; time windows and endpoints must not be mixed. [1]
| Stage | 30-day PE-related complications | In-hospital PE-related complications | 30-day PE-related mortality |
|---|---|---|---|
| I | 4.2% | 3.6% | 1.7% |
| II | 10.8% | 9.7% | 5.0% |
| III | 29.2% | 28.0% | 15.5% |
Prospective validation: rates vary across cohorts
The 2018 prospective validation enrolled 639 consecutive normotensive acute-PE patients. Its 30-day composite of PE-related mortality, hemodynamic collapse and nonfatal PE recurrence occurred in 7.0% overall: Stage I 2.9%, Stage II 17%, Stage III 27%. All-cause mortality was 5.3% and did not substantially differ by stage. These outcomes are not merged with the 2014 data into a synthetic probability. [2]
Troponin and RV imaging evidence
The pooled model uses binary elevated cardiac troponin and RV dysfunction assessed by echocardiography or CT. Cohort assays, reference thresholds and operational imaging definitions differ. Use the externally established classifications from this assessment; there is no universal numeric troponin or RV/LV threshold added here. Missing testing is not a negative result. [1]
Current guidance supports structured RV assessment, but that does not replace the original Bova binary predictor with a new imaging calculator. The 2026 guideline has a separate correction; no Bova scoring change is attributed to that correction. [3, 4]
Current 2026 AHA/ACC limits
Table 6 retains the four Bova weights and original stages. The current clinical-category framework uses Bova ≤4 as an example of a Low clinical-severity score and >4 as Elevated. The full categories additionally require clinical, hemodynamic, laboratory, imaging and respiratory information. Hypotension, cardiopulmonary failure, normotensive shock or hypoperfusion, MAP, lactate, AKI/urine output and cardiac index are not all captured by Bova. A low total cannot override deterioration. [3]
No stage mandates thrombolysis or another intervention. This calculator does not choose a medicine, dose, monitoring interval, admission, discharge or home treatment. Do not delay clinical care to complete it.
Bova vs PESI, NEWS2 and other PE tools
PESI/sPESI use broader clinical variables for short-term, principally all-cause-mortality-oriented prognosis after confirmed PE. Bova focuses on PE-related complications within its normotensive source population and uses cardiac biomarker/RV imaging evidence; the models can disagree and are not interchangeable. NEWS2 measures general physiological deterioration rather than this PE-specific endpoint. [1, 3]
Wells PE concerns suspected-PE pretest probability, PERC is conditional rule-out, and YEARS combines suspected-PE criteria with D-dimer. Hestia is a separate outpatient eligibility/exclusion framework. CPES is a separate 0–6 model incorporating troponin, BNP, RV function, central thrombus burden, concomitant DVT and HR ≥100. None is calculated or converted from Bova here. [3]
References
- Bova C, Sanchez O, Prandoni P, et al. Identification of intermediate-risk patients with acute symptomatic pulmonary embolism. Eur Respir J. 2014;44(3):694–703. PMID 24696111. DOI 10.1183/09031936.00006114.
- Bova C, Vanni S, Prandoni P, et al. A prospective validation of the Bova score in normotensive patients with acute pulmonary embolism. Thromb Res. 2018;165:107–111. PMID 29631073. DOI 10.1016/j.thromres.2018.04.002.
- Creager MA, Barnes GD, Giri J, et al. 2026 AHA/ACC/ACCP/ACEP/CHEST/SCAI/SHM/SIR/SVM/SVN Guideline for the Evaluation and Management of Acute Pulmonary Embolism in Adults. Circulation. 2026;153:e977–e1051. PMID 41712677. DOI 10.1161/CIR.0000000000001415.
- Creager MA, Barnes GD, Giri J, et al. Correction to the 2026 Acute Pulmonary Embolism Guideline. Circulation. 2026;154(2):e24. PMID 42441758. DOI 10.1161/CIR.0000000000001462.
FAQ
The original Bova 2014 index stratifies 30-day PE-related complications after confirmed acute symptomatic pulmonary embolism in a normotensive population. Its endpoint combines PE-related death, hemodynamic collapse and recurrent PE, not all-cause mortality alone. It does not diagnose PE.
Sources: [1]
Yes. Both 90 and 100 mmHg are included in the 2-point band; 101 scores zero SBP points. Below 90 is outside the original normotensive scoring range, so this calculator withholds the entire score and stage. Hypotension or clinical deterioration requires separate assessment, not a reassuring zero-point interpretation.
Use the elevation status established for the applicable cardiac-troponin assay and reference framework in this PE assessment. Bova pooled cohorts with differing assays and thresholds. QuickMedCalc accepts only the binary status and neither reinterprets a concentration nor imposes one universal numeric cutoff. Missing testing is not a negative result.
Sources: [1]
The source accepts documented RV dysfunction assessed by echocardiography or CT. Operational definitions vary. Use the imaging classification already established for this assessment; the calculator does not create an RV/LV cutoff or infer RV dysfunction from troponin, ECG, symptoms or another score. An unavailable assessment is not an assessed negative finding.
The original 2,874-patient analysis observed 30-day PE-related complications of 4.2%, 10.8% and 29.2% in Stages I, II and III. In 639 prospectively enrolled patients in 2018, the composite occurred in 7.0% overall, with stage rates of 2.9%, 17% and 27%. All-cause mortality was 5.3% and did not substantially differ by stage. The cohorts are not averaged into a synthetic probability.
Yes. PESI/sPESI use broader clinical variables and principally short-term all-cause-mortality-oriented prognosis after confirmed PE. Bova focuses on PE-related complications in normotensive patients using BP, pulse, troponin and RV imaging. They are independently defined models, not interchangeable scales or automatic treatment rules.
NEWS2 is a general physiological deterioration score. Wells PE, PERC and YEARS belong to suspected-PE evaluation; Bova applies after PE is confirmed in its source-normotensive context. This page does not import or cross-convert any of those scores.
Sources: [3]
No. Hestia is a separate outpatient eligibility/exclusion framework. CPES uses different predictors and a different 0–6 scale. Bova neither calculates them nor authorizes discharge, admission, home treatment or an intervention.
Sources: [3]
Neither follows from Bova alone. Current assessment includes hemodynamics, hypoperfusion, respiratory findings, biomarkers, imaging and other clinical information. Shock or deterioration overrides a static score. QuickMedCalc does not choose therapy, medication, dose, monitoring interval or disposition.
Sources: [3]
Related Calculators
PESI / sPESI
Calculate original PESI and independently validated simplified PESI after confirmed acute pulmonary embolism from direct vital signs and source-defined clinical factors.
NEWS2 Score
Calculate the current RCP NEWS2 adult acute-illness score from a complete observation set, including the correct SpO₂ scale, oxygen uplift, red-score components, and trigger category.
YEARS Criteria
Apply standard or pregnancy-adapted YEARS to three clinical criteria and an explicitly labeled FEU D-dimer, including the pregnancy compression-ultrasound branch.
Disclaimer
Educational and informational reference only. Not intended to replace professional medical advice, diagnosis, treatment, or independent verification.