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Community-Acquired Pneumonia
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CURB-65


The CURB-65 is a simple scoring system easily used in the outpatient office or emergency room setting, which assigns 1 point for each of 5 clinical features:

  Clinical Factor Points
C Confusion 1
U Blood urea nitrogen > or = 20 mg/dL 1
R Respiratory rate > or = 30 breaths/min 1
B

Systolic BP < 90 mm Hg or Diastolic BP < or = 60 mm Hg

1
65 Age > or = 65 1



CURB-65 ALGORITHM
A single point is given for the presence of delirium or confusion, a blood urea nitrogen value greater than or equal to 20, a respiratory rate greater than or equal to 30, a systolic blood pressure less than 90 mm Hg or a diastolic blood pressure less than or equal to 60, and an age greater than or equal to 65 years of age.

If the cumulative score is 0 or 1, then most likely this patient could be safely treated as an outpatient.

A score of 2 might suggest closely supervised outpatient treatment, or inpatient observation admission.  A score of 3, 4, or 5 would usually indicate inpatient treatment.

It is important to emphasize that clinical judgment should be the primary factor in the decision for hospital admission, with the CURB-65 score providing assistance with this decision.



Total Score
Mortality %
Risk Level Suggested Site-of-Care
0
0.6%
Low Outpatient
1
2.7%
Low Outpatient
2
6.8%
Moderate Short inpatient / supervised outpatient
3
14.0%
Moderate to High Inpatient
4 or 5
27.8%
High Inpatient / ICU



 




The Ohio State University | College of Medicine
Division of Pulmonary, Allergy, Critical Care & Sleep Medicine
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