How to Predict Death from Community-Acquired Pneumonia

On the Shoulders of Giants

CRBside consult
Should the patient be admitted or treated as an outpatient for pneumonia?  Scores like the PSI, SMART-COP, CURB, CRB, CRB-65, and CURB-65 are all tools to help make these decisions at the bedside.  This prospective study of over 1300 patients with pneumonia found that CURB, CRB, and CRB-65 all had similar overall diagnostic performance.  Subsequently, further studies have validated CURB-65, which is now more commonly used.  CURB-65 looks at these 5 clinical variables:

  • Confusion
  • BUN > 19 mg/dL (> 7 mmol/L)
  • Respiratory Rate ≥ 30
  • Systolic BP < 90 mmHg or Diastolic BP ≤ 60 mmHg
  • Age ≥ 65

The best way to get a feel for this clinical prediction instrument is to use MDCalc.  Any score of 2 or more usually benefits from hospitalization.  Higher scores may indicate the need for critical care.

Spoon Feed
Use a score like CURB-65 (or CRB-65 if you don't have labs) when making clinical decisions about the disposition of patients with community acquired pneumonia.  For a great quick read, see Michelle Lin's ALiEM Paucis Verbis card on pneumonia scores.

CRB-65 predicts death from community-acquired pneumonia. J Intern Med. 2006 Jul;260(1):93-101.

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