Assessing the severity of pneumonia – CURB-65

When you see someone with suspected pneumonia you think “well, they have pneumonia, but how sick are they reaaalllly?” (you would ideally think this while cocking an eyebrow and tilting your head slightly)

To help you determine whether you send the person home on their merry way or admit them to hospital, you can use the CURB-65 pneumonia severity score.

  1. Confusion
  2. Urea >7
  3. Respiratory rate >30 breaths per minute
  4. Blood pressure <90 systolic or <60 diastolic
  5. 65 years or older

Each of the five criteria is worth 1 point, add them together:

  • 0 – 1 points: mild pneumonia (there’s only a 3% chance that your patient will go home and die, leaving you racked with guilt)
  • 2 points: moderate (9% risk of dying) – you should probably hospitalize this person
  • 3 – 5 points: severe (13-53% chance of dying) – you better admit this person, maybe even to the ICU

Lim WS, van der Eerden MM, Laing R, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003 May;58(5):377-82.
Lim WS, Baudouin SV, George RC, et al. BTS guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009 Oct;64 Suppl 3:iii1-55.

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