Objective To evaluate the clinical diagnostic and exclusive values of revised Geneva score and its combination with plasma level of D-dimer for suspected pulmonary embolism (PE) in the elderly patients. Methods A total of 276 patients with suspected PE due to chest pain and dyspnea admitted in our hospital from January 2009 to April 2014 were enrolled in this study. They were divided into 2 groups based on their age, that is, the aged group (≥60 years old) and the non-aged group (＜60 years old). Computed tomography pulmonary arteriography (CTPA) was considered as the gold standard for diagnosis. According to the revised Geneva score, the diagnosis of PE was categoried into different clinical probability, ie, low, medium and high probability, and their plasma level of D-dimer was also tested. Based on their clinical features, the diagnostic values of revised Geneva score, the exclusive values of plasma D-dimer, and that of combining revised Geneva score with D-dimer together were analyzed between the 2 groups. The receiver operating characteristics (ROC) curve was used to evaluate the overall accuracy of revised Geneva score in the diagnosis of PE. Results Among the cohort with suspected PE, 80 cases were definitely diagnosed as PE by CTPA (52 cases ≥60 years old, and 28 cases ＜60 years old). The area under the ROC curve (AUC) was 0.974 (95% CI: 0.940?0.992) for the aged group and 0.981 (95% CI: 0.924?0.998）for the non-aged one, with significant difference between them (P＜0.001). The negative predictive values of D-dimer, and the revised Geneva score combined with D-dimer were 93.8% and 100.0% respectively for the aged patients, and 88.9% and 100.0% for the non-aged patients. Conclusion The clinical features of PE are atypical in the elderly patients. The revised Geneva score has lower diagnostic value for the aged than the non-aged patients. Combination of revised Geneva score and plasma level of D-dimer is a safe strategy to rule out PE and is better than D-dimer alone for the aged and non-aged patients with suspected PE.