Can CURB-65 Predict ICU-Level Care for Pneumonia?

Written by Clay Smith

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CURB-65 was a poor predictor of the need for critical care intervention in adult patients with community acquired pneumonia.

Why does this matter?
We are encouraged to use objective scoring systems to determine or justify the need for pneumonia admission.  CURB-65 is a straightforward scoring system: 0 to 1 = outpatient; 2 = inpatient; ≥3 = inpatient and possible ICU care.  How does this pan out in practice?

Kick it to the CURB?
This was a single center retrospective study of adult ED patients admitted for pneumonia.  They calculated the CURB-65 score for 2322 patients and found it was a poor predictor of need for critical care intervention*.  Of the patients with a "low-risk" 0 to 1 score, 12.2% received a critical care intervention; 15.6% (181/1159) were admitted or transferred to the ICU within 48 hours.  Of those with a score of 2, 15.4% received a critical care intervention; 27% (223/826) ended up in the ICU.  Overall accuracy of CURB-65 was 73%; sensitivity of a score ≥2 for critical care intervention was 78.4%.  Bottom line - this score is not very helpful.  Let your judgment and common sense prevail, and consider using a different pneumonia score, like the PSI/PORT score, which is better at predicting ICU admission than CURB-65.

*Critical care intervention was defined as: use of vasopressor or inotropic support agents, receipt of assisted ventilation (including non-invasive), receipt of a continuous insulin infusion, receipt of greater than 4L of intravenous fluid within 12 hours of ICU admission, placement of invasive catheters, or dialysis.

Source
Performance of the CURB-65 Score in Predicting Critical Care Interventions in Patients AdmittedWith Community-Acquired Pneumonia.  Ann Emerg Med. 2018 Aug 2. pii: S0196-0644(18)30548-1. doi: 10.1016/j.annemergmed.2018.06.017. [Epub ahead of print]
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Reviewed by Thomas Davis

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