Introduction: The revised Geneva score, a standardized clinical decision rule in the diagnosis of PE, was recently developed. The Wells clinical decision is widely used but lacks full standardization since it includes subjective clinician's judgment. We have compared the performance of the revised Geneva score with the Wells rule and their usefulness to rule out PE in combination with D-dimer measurement. Methods: In 300 consecutive patients, the clinical probability of PE was assessed prospectively by the Wells rule and retrospectively using the revised Geneva score. Patients were a random sample from a single centre, participating in a large prospective multi-centre diagnostic study. The predictive accuracy of both scores was compared by AUC of ROC-curves. Results: The overall prevalence of PE was 16%. The prevalence of PE in the low, intermediate and high probability categories as classified by the revised Geneva score was similar to that of the original derivation set. The performance of the revised Geneva score as measured by the AUC in a ROC analysis did not differ statistically from the Wells rule. After 3 months of follow up, no patient classified into the low or intermediate clinical probability score by the revised Geneva score and a normal D-dimer result was subsequently diagnosed with acute VTE. Conclusion: This study suggests that the performance of the revised Geneva score is equivalent to that of the Wells rule. In addition, it seems safe to exclude PE in patients by the combination of a low or intermediate clinical probability by the revised Geneva score and a normal D-dimer level. Prospective clinical outcome studies are needed to confirm this latter finding.