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    CURB-65 Score for Pneumonia Severity

    Estimates mortality of community-acquired pneumonia to help determine inpatient vs. outpatient treatment.
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    When to Use
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    Why Use

    The CURB-65 calculator can be used in the emergency department setting to risk stratify a patient’s community acquired pneumonia.

    • The CURB-65 Score includes points for confusion and blood urea nitrogen, which in the acutely ill elderly patient, could be due to a variety of factors. An alternative scoring system, SOAR, circumvents those two parameters. It uses low systolic BP (S) and poor oxygenation (PaO2: FIO2) (O), advancing age (A), high respiratory rate (R).
    • CURB-65 does not assign points for co-morbid illness and nursing home residence, as the original study did account for many of these conditions.
    • CURB-65 may not identify patients requiring ICU admission as well as the PSI.
    • CURB-65 is fast to compute, requires likely already-available patient information, and provides an excellent risk stratification of community acquired pneumonia. It can facilitate better utilization of resources and treatment initiation.
    • In comparison to the PSI, CURB-65 offers equal sensitivity of mortality prediction due to community acquired pneumonia. Notably, CURB-65 (74.6%) has a higher specificity than PSI (52.2%).

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    Advice

    While many pneumonias are actually viral in nature, typical practice is to provide a course of antibiotics given the pneumonia may be bacterial.

    Disposition (inpatient vs. outpatient) often dictates further care and management -- including lab testing, blood cultures, etc.

    Management

    The CURB-65 scores range from 0 to 5. Assign points as in the table based on confusion status, urea level, respiratory rate, blood pressure, and age. Clinical management decisions can be made based on the score, as described in the validation study below:

    ScoreRiskDisposition
    0 or 11.5% mortalityOutpatient care
    29.2% mortalityInpatient vs. observation admission
    ≥ 322% mortalityInpatient admission with consideration for ICU admission with score of 4 or 5

    Critical Actions

    For patients scoring high on CURB-65, it would be prudent to ensure initial triage has not missed the presence of sepsis. Evaluation of SIRS criteria would be beneficial.

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    Dr. John Macfarlane
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