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CURB-65 Score for Pneumonia Severity

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

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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