Bova Score for Pulmonary Embolism Complications

Why did you develop the Bova Score? Was there a particular clinical experience or patient encounter that inspired you to create this tool for clinicians?

Risk stratification in patients with acute pulmonary embolism is important to guide patient management. Most patients with normal blood pressure go well if treated with anticoagulants, but some have adverse events related to pulmonary embolism. Great efforts have been made to realize a tool able to identify these so-called “intermediate-risk” patients. The Bova Score has been created for this purpose. It was the result of an international collaboration of seven authors who pooled the results of six European cohort studies.

What pearls, pitfalls and/or tips do you have for users of the Bova Score? Do you know of cases when it has been applied, interpreted, or used inappropriately?

Stage I of the Bova Score should not be used to identify low-risk PE patients eligible for early discharge or outpatient therapy because it does not consider relevant comorbidities such as cancer or cardiopulmonary diseases.      

What recommendations do you have for doctors once they have applied the Bova Score? Are there any adjustments or updates you would make to the score based on new data or practice changes?

Patients belonging to stage III should be closely monitored to rapidly identify hemodynamic deterioration. However, this stage should not be considered, as a single criterion, a compelling  indication for the thrombolysis.

How do you use the Bova Score in your own clinical practice? Can you give an example of a scenario in which you use it?

In my opinion, the best scenario for using the Bova Score is in the emergency department.

Why was oxygen saturation <90% not included as part of the scoring system? It appears to be a significant finding to predict PE-related complications.

Oxygen saturation <90%  was not included in the scoring system because it was associated with 30-day pulmonary embolism-related complications in the univariate, but not in the multivariate, analysis.

Any thoughts on the modified Bova Score (Keller et al, 2015)?

The article by Keller and collaborators is very interesting because it showed that the Bova Score is useful in predicting adverse events even in hemodynamically unstable patients. However, these results should be confirmed.

Any other research in the pipeline that you’re particularly excited about?

Our group has recently completed a multicenter prospective validation of the Bova Score. We hope the results will be publicly available soon.

Carlo Bova, MD, is an internal medicine physician at Annunziata General Hospital in Cosenza, Italy. He is also one of the investigators of the PESIT (Prevalence of Pulmonary Embolism Among Patients Hospitalized for Syncope) study. Dr. Bova's research interest is in venous thromboembolism, and he has published several papers in this field.