Bova Score for Pulmonary Embolism (PE): Calculator, Modified Bova Criteria, and Risk Stratification

Bova Score for Pulmonary Embolism (PE):

• What is Bova Score for Pulmonary Embolism?
• Calculator
• Modified Bova Criteria
• Risk Stratification

What is Bova Score for Pulmonary Embolism?

The Bova Score is a clinical risk-stratification tool used to predict early complications in patients diagnosed with acute pulmonary embolism (PE). Unlike other scoring systems that focus on diagnosing PE, the Bova Score is applied after PE is confirmed to determine the patient’s short-term risk of deterioration. It helps identify which patients may require closer monitoring, hospitalization, or urgent intervention.

Developed from large observational studies, the Bova Score assesses intermediate-risk PE patients who do not present with shock but may still experience adverse outcomes such as hemodynamic collapse, need for vasopressors, or mortality within 30 days. By using simple bedside parameters such as heart rate, systolic blood pressure, troponin elevation, and right ventricular dysfunction, clinicians can stratify patients into different risk categories that guide management decisions.

Calculator

A Bova Score calculator uses four clinical variables to determine the risk category. Each variable is assigned a specific point value:

• Systolic blood pressure 90–100 mmHg → 2 points
• Heart rate ≥ 110 bpm → 1 point
• Elevated cardiac troponin → 2 points
• Right ventricular (RV) dysfunction on imaging → 2 points

The total score ranges from 0 to 7. Clinicians can calculate it manually or with online calculators integrated into PE management algorithms. The calculator is useful in emergency departments, hospital wards, and intensive care units. Its simplicity allows rapid assessment with a high degree of accuracy, supporting early recognition of patients at higher risk of deterioration.

Bova Score — PE Risk Calculator

Enter the values below to calculate Bova score (0–7) and risk stage.

Systolic blood pressure (mmHg)

Heart rate (bpm)

Elevated cardiac troponin

RV dysfunction (echo/CT)

Score: —

Note: Bova applies only to *normotensive* PE (SBP ≥ 90 mmHg).

Once the total score is obtained, patients are categorized into three risk stages that correlate with 30-day complication rates. This information helps determine whether the patient may need advanced therapies such as thrombolytics, catheter-directed interventions, or close hemodynamic monitoring.

Modified Bova Criteria

The Modified Bova Criteria refine the original scoring system by enhancing prediction accuracy across broader patient populations. While the core variables remain similar, modifications may include adjusted point assignments or additional clinical markers depending on the variation used. The goal is to improve sensitivity and specificity for predicting early PE-related complications.

Some modified versions incorporate biomarkers such as BNP/NT-proBNP or expand imaging parameters for right ventricular strain. These refinements help categorize intermediate-risk patients more precisely, especially those who may deteriorate rapidly despite appearing stable on initial evaluation. Clinical guidelines often reference both the original and modified versions to individualize treatment strategies.

Risk Stratification

The Bova Score stratifies PE patients into three risk stages:

• Stage I (0–2 points) – Low risk of early complications (approx. 4%).
• Stage II (3–4 points) – Intermediate risk (approx. 10%).
• Stage III (≥ 5 points) – High risk of early deterioration (approx. 30%).

These categories help clinicians determine the level of care required. Stage I patients may often be managed on a medical ward or considered for outpatient treatment if no other risks are present. Stage II patients typically require inpatient observation and possibly early imaging follow-up. Stage III patients may need ICU monitoring, aggressive therapy, and evaluation for thrombolysis or catheter-directed clot removal.

Risk stratification using the Bova Score complements other tools such as PESI, sPESI, and imaging findings. Together, these systems create a more complete picture of patient stability and allow providers to intervene before complications occur. Proper use of the Bova Score enhances patient safety, optimizes therapy selection, and improves PE outcomes.