On the Shoulders of Giants
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:
- 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.
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.