CURB-65 Score for Pneumonia Severity

Confusion

BUN >19 mg/dL (>7 mmol/L)

Respiratory Rate ≥30

SBP <90 mmHg or DBP ≤60 mmHg

Age ≥65

CURB-65 Score: 0

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

Why Use

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%).

When to Use

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

Formula

Addition of the selected points, as above.

Pearls / Pitfalls

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 (PaO 2 :FiO 2 ) (O), advancing age (A), high respiratory rate (R). CURB-65 does not assign points for comorbid illness and nursing home residence, as the original study did account for many of these conditions. A meta-analysis showed that CURB-65 performed slightly better in prediction of mortality and need for ICU management compared to the PSI .

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: Score Risk Disposition 0 or 1 1.5% mortality Outpatient care 2 9.2% mortality Inpatient vs. observation admission ≥3 22% mortality Inpatient 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.

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.

More Information

Score interpretation (as per derivation study): CURB-65 score Mortality Risk Recommendation per Derivation Study 0 0.60% Low risk; consider home treatment 1 2.70% Low risk; consider home treatment 2 6.80% Short inpatient hospitalization or closely supervised outpatient treatment 3 14.00% Severe pneumonia; hospitalize and consider admitting to intensive care 4 or 5 27.80% Severe pneumonia; hospitalize and consider admitting to intensive care