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Bova Score for Pulmonary Embolism Complications

Calculators  Cardiovascular
The Bova Score is used to predict an individual's risk for complications from a pulmonary embolism. A pulmonary embolism is a clot in the lungs. The Bova Score incorporates information from systolic blood pressure, heart rate, the presence of cardiac troponin, and the presence of left ventricular dysfunction.
Systolic BP
If sBP <90, patient not eligible for Bova scoring
>100 mm Hg 0
90-100 mmHg 2
Elevated Cardiac Troponin
Standard assay and lab cutoff value
No 0
Yes 2
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)
No 0
Yes 2
Heart rate
<110 0
≥110 1


Measured Factor
Bova Score
Measured Factor Disease
  • Risk for pulmonary embolism-related complications
Measured Factor Detail
The BOVA Score is used to predict a patient's risk of having any pulmonary embolism-related complications thirty days after diagnosis. Pulmonary embolism-related complciations may include death, recurrent emboli, and hemodynamic collapse. For those with higher scores, additional therapies may be required to avoid potential complications. This may include additional monitoring, medications, procedures, and/or medical devices.
Vascular Surgeon
Body System
Measured Factor Low Impact
  • Low risk for pulmonary embolism-related complications
Measured Factor High Impact
  • Patients with a BOVA score greater than 4 are at high risk for experiencing pulmonary embolism-related complications.
  • N/A

Result Interpretation

Ranges Ranges
  • Critical Low: 3-4 points
  • Critical High: >4 points
  • Normal: 0-2 points
  • Normal Adult Male: N/A
  • Normal Adult Female: N/A
  • Normal Pediatric: N/A
  • Normal Neonate Female: N/A
  • Normal Geriatric Male: N/A
  • Normal Geriatric Female: N/A
Result Low Conditions
  • N/A
Result High Conditions
  • Recurrent pulmonary embolism
False Positive
  • Tachycardia
  • elevated troponin
  • right ventricular dysfunction
References: 2
Test Limitations
References: 2


Study Validation 1
The Bova Score has shown utility in identifying pulmonary embolism patients with intermediate to high risk for complications. The aim of the study was to prove the score valid in a variety of settings. Complications such as morality, hemodynamic collapse, and embolism recurrence were observed for 30 days after the pulmonary embolism. 

639 patients were included in the study. 45 patients experienced complications within the 30 days. Stage III Bova Score patients experienced 6.5 times more adverse events. The Bova Score accurately categorized patients based on risk for complications 30 days after a pulmonary embolism.
References: 3
Study Validation 2
The Bova Score categorizes pulmonary embolism patients based on their risk for complications 30 days after the embolism. The aim of the study was to assess the validity of the Bova Score in predicting complications 30 days after the embolism.  

1083 patients were included in the retrospective study. 80% of the patient were classified into the low risk category. Complications occurred in 91 patients. Those given higher Bova Scores experienced more complications and mortality. The Bova Score accurately categorized patients based on risk for complications 30 days after a pulmonary embolism.
References: 4
Study Validation 3
References: 2
Study Additional 1
The Bova Score is used to classify patients based on risk for complications after a pulmonary embolism. The aim of this study was to evaluate a modified Bova Score. The Bova Score was modified to include both normotensive and hemodynamically unstable patients. 

Taking place between May 2006 and June 2011, this retrospective study included 130 patients. Patients with a Bova Score greater than or equal to 4 experienced higher mortality while inpatient and a higher risk pulmonary embolism status. The modified Bova Score is effective in predicting pulmonary embolism outcomes.
References: 5
Study Additional 2
This study aimed to evaluate the European Society of Cardiology 2014 algorithm and the Bova Score in their ability to predict a patient’s risk for complications after a pulmonary embolism. This retrospective study defined complications as death, hemodynamic collapse, and a recurrent pulmonary embolism. 

The European Society of Cardiology algorithm is useful in categorizing patients based on risk. The Bova Score is not useful in identifying intermediate and high-risk patients.
References: 6
Study Additional 3
References: 2


Carlo Bova
MD, Annunziata General Hospital in Cosenza, Italy, Internal Medicine Physician


  1. Bova C, Sanchez O, Prandoni P, Lankeit M, Konstantinides S, Vanni S, Jiménez D. Identification of intermediate-risk patients with acute symptomatic pulmonary embolism. Eur Respir J. 2014 Sep;44(3):694-703. doi: 10.1183/09031936.00006114.
  2. N/A
  3. Bova C, Vanni S, Prandoni P, Morello F, Dentali F, Bernardi E, Mumoli N, Bucherini E, Barbar S, Picariello C, Enea I, Pesavento R, Bottino F, Jiménez D; Bova Score Validation Study Investigators. A prospective validation of the Bova score in normotensive patients with acute pulmonary embolism. Thromb Res. 2018 May;165:107-111. doi: 10.1016/j.thromres.2018.04.002.
  4. Fernández C, Bova C, Sanchez O, Prandoni P, Lankeit M, Konstantinides S, Vanni S, Fernández-Golfín C, Yusen RD, Jiménez D. Validation of a Model for Identification of Patients at Intermediate to High Risk for Complications Associated With Acute Symptomatic Pulmonary Embolism. Chest. 2015 Jul;148(1):211-218. doi: 10.1378/chest.14-2551.
  5. Keller K, Beule J, Balzer JO, Dippold W. Modified Bova score for risk stratification and short-term outcome in acute pulmonary embolism. Neth J Med. 2015 Nov;73(9):410-6.
  6. Jimenez D, Lobo JL, Fernandez-Golfin C, Portillo AK, Nieto R, Lankeit M, Konstantinides S, Prandoni P, Muriel A, Yusen RD; PROTECT investigators. Effectiveness of prognosticating pulmonary embolism using the ESC algorithm and the Bova score. Thromb Haemost. 2016 Apr;115(4):827-34. doi: 10.1160/TH15-09-0761.

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