_id

683a15f2c782e11e38d1b0b1

id

324

title

CURB-65 Score for Pneumonia Severity

full_title

CURB-65 Score for Pneumonia Severity

short_title

CURB-65 Score

med_description

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

short_description

Mortality in CAP: inpatient vs outpatient.

slug

curb-65-score-pneumonia-severity

description

The CURB-65 Severity Score estimates mortality of community-acquired pneumonia to help determine inpatient vs. outpatient treatment.

keywords

CURB-65 Severity Score, curb severity, curb pna, curb pneumonia, curb score, curb 65 score, curb-65 score, curb-65 severity, curb-65 pna, curb-65 pneumonia, curb calc, curb-65 calc, curb-65 online, pna severity calc, pna severity score, pna prognosis, pneumonia severity calc, pneumonia severity score, curb65

complaint

[ "Cough", "Fever", "Shortness of Breath" ]

formula

Addition of the selected points, as above.

evidence

The original study was a retrospective review of three prospective studies of CAP in the UK, New Zealand, and the Netherlands. It included a total of 1068 patients. A five-point score based on confusion, urea, respiratory rate, blood pressure, and age was developed to stratify patients into different treatment group based on mortality risk. The validation study was done in India and included 150 patients.

CURB-65’s original study including co-morbidity variables like chronic lung disease, chronic liver disease, CHF, CVD, and DM, and these were controlled for when developing the relevant criteria for the risk stratification that ultimately led to CURB-65’s risk factors.

Several other more recent validation studies in several different countries show increasing mortality and even need for intubation with increasing CURB-65 scores, ranging from 0-1.1% (CURB-65 score = 0) to 17-60% (CURB-65 score = 5), with over 3100 patients in these studies when combined.

CURB-65 has been shown to be an effective predictor of mortality in patients with COVID-19, and that other clinical markers (such as D-dimer or procalcitonin) do not improve it’s accuracy (Bradley et al).

Finally, a meta-analysis showed that CURB-65 performed slightly better in prediction of mortality and need for  ICU management compared to the PSI.

measurements

[]

information

Score interpretation (as per derivation study):

refrences

{ "Clinical Practice Guidelines": [ { "href": "https://pubmed.ncbi.nlm.nih.gov/31573350/", "text": "Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the american thoracic society and infectious diseases society of america. Am J Respir Crit Care Med. 2019;200(7):e45-e67." } ], "Manufacturer Website": [], "Original/Primary Reference": [ { "href": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1746657/?tool=pmcentrez", "text": "W Lim, M M van der Eerden, R Laing, W Boersma, N Karalus, G Town, S Lewis, and J Macfarlane. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003 May; 58(5): 377–382. doi: 10.1136/thorax.58.5.377." } ], "Other References": [], "Outcomes": [], "Validation": [ { "href": "https://pubmed.ncbi.nlm.nih.gov/20364609/", "text": "Shah BA, et. al. Validity of Pneumonia Severity Index and CURB-65 Severity Scoring Systems in Community Acquired Pneumonia in an Indian Setting. The Indian Journal of Chest Diseases & Allied Sciences. 2010;Vol.52." }, { "href": "https://www.ncbi.nlm.nih.gov/pubmed/15808136", "text": "Aujesky D, Auble TE, Yealy DM, et al. Prospective comparison of three validated prediction rules for prognosis in community-acquired pneumonia. Am. J. Med. 2005;118(4): 384–92.doi:10.1016/j.amjmed.2005.01.006. PMID 15808136" }, { "href": "https://www.ncbi.nlm.nih.gov/pubmed/16638769", "text": "Myint PK, Kamath AV, Vowler SL, Maisey DN, Harrison BD. Severity assessment criteria recommended by the British Thoracic Society (BTS) for community-acquired pneumonia (CAP) and older patients. Should SOAR (systolic blood pressure, oxygenation, age and respiratory rate) criteria be used in older people? A compilation study of two prospective cohorts. Age Ageing. 2006;35(3):286-91." }, { "href": "https://www.ncbi.nlm.nih.gov/pubmed/16387948", "text": "Capelastegui A, España PP, Quintana JM, et al. Validation of a predictive rule for the management of community-acquired pneumonia. Eur Respir J. 2006;27(1):151-7." }, { "href": "https://pubmed.ncbi.nlm.nih.gov/34740594/", "text": "Bradley J, Sbaih N, Chandler TR, Furmanek S, Ramirez JA, Cavallazzi R. Pneumonia severity index and curb-65 score are good predictors of mortality in hospitalized patients with sars-cov-2 community-acquired pneumonia. Chest. 2022;161(4):927-936." }, { "href": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10462911/", "text": "Zaki HA, Hamdi Alkahlout B, Shaban E, et al. The battle of the pneumonia predictors: a comprehensive meta-analysis comparing the pneumonia severity index (Psi) and the curb-65 score in predicting mortality and the need for icu support. Cureus. 15(7):e42672." } ], "Validations": [] }

pearls

• 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 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.

usecase

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

reasons

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 thePSI, 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%).

next_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.

next_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.

next_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:

diseases

[ "Coronavirus", "COVID-19", "Pneumonia" ]

input_schema

[ { "conditionality": "", "default": 0, "label_en": "<p>Confusion</p>", "md_calc_info_concept": null, "name": "confusion", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": true, "tips_en": "", "type": "toggle" }, { "conditionality": "", "default": 0, "label_en": "<p>BUN &gt;19 mg/dL (&gt;7 mmol/L urea)</p>", "md_calc_info_concept": null, "name": "bun", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": true, "tips_en": "", "type": "toggle" }, { "conditionality": "", "default": 0, "label_en": "<p>Respiratory Rate &ge;30</p>", "md_calc_info_concept": null, "name": "respiratory_rate", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": true, "tips_en": "", "type": "toggle" }, { "conditionality": "", "default": 0, "label_en": "<p>Systolic BP &lt;90 mmHg or Diastolic BP &le;60 mmHg</p>", "md_calc_info_concept": null, "name": "systolic_diastolic_bp", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": true, "tips_en": "", "type": "toggle" }, { "conditionality": "", "default": 0, "label_en": "<p>Age &ge;65</p>", "md_calc_info_concept": null, "name": "age_65", "option_fhir_rules": null, "optional": false, "options": [ { "label": "No", "value": 0 }, { "label": "Yes", "value": 1 } ], "show_points": true, "tips_en": "", "type": "toggle" } ]

instructions

published

2022-04-21T20:29:14.295Z

purpose

[ "Prognosis" ]

search_terms

[ "cap", "pna", "crb", "community-acquired pneumonia", "covid", "covid-19", "coronavirus", "curb", "curb 65" ]

seo

{ "keywords_en": "CURB-65 Severity Score, curb severity, curb pna, curb pneumonia, curb score, curb 65 score, curb-65 score, curb-65 severity, curb-65 pna, curb-65 pneumonia, curb calc, curb-65 calc, curb-65 online, pna severity calc, pna severity score, pna prognosis, pneumonia severity calc, pneumonia severity score, curb65", "meta_description_en": "The CURB-65 Severity Score estimates mortality of community-acquired pneumonia to help determine inpatient vs. outpatient treatment." }

specialty

[ "Critical Care", "Emergency Medicine", "Family Practice", "Geriatrics", "Hospitalist Medicine", "Infectious Disease", "Internal Medicine", "Palliative Care/Hospice", "Pulmonology", "Rehabilitation Medicine" ]

departments

[ "Cardiac", "Infectious", "Respiratory" ]

tags

[]

version_number

1

versions

[]

related

[ { "calcId": 33, "short_title_en": "PSI/PORT Score", "slug": "psi-port-score-pneumonia-severity-index-cap" }, { "calcId": 3914, "short_title_en": "SMART-COP Score", "slug": "smart-cop-score-pneumonia-severity" }, { "calcId": 10278, "short_title_en": "PIRO Score for CAP", "slug": "piro-score-community-acquired-pneumonia" } ]

ismed

true

section

[ "whenToUseViewed", "pearlsPitfallsViewed", "whyUseViewed", "nextStepsViewed", "evidenceViewed" ]

cleaned_departments

[ "cardiology", "infectious", "pulmonology" ]

cleaned_use

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

pub

true