CURB-65

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CURB-65 is a validated score for predicting mortality in community-acquired pneumonia[1][2] and infection of any site[3]. The CURB-65 is based on the earlier CURB score[4] and is recommended by the British Thoracic Society for the assessment of severity of pneumonia.[5]

The score is an acronym for each of the risk factors measured. Each risk factor scores one point, for a maximum score of 5:

  • confusion (defined as an AMT of 8 or less)
  • urea greater than 7 mmol/l (19.6 mg/dl)
  • respiratory rate of 30 breaths per minute or greater
  • blood pressure less than 90 systolic or diastolic blood pressure 60 or less
  • age 65 or older

Removing the effect of age may improve accuracy.[6] A variation is the CURB-age.[7]

Predicting death from pneumonia

The risk of death increases as the score increases:

  • 0—0.7%
  • 1—3.2%
  • 2—13.0%
  • 3—17.0%
  • 4—41.5%
  • 5—57.0%

The CURB-65 has been compared to the pneumonia severity index in predicting mortality from pneumonia and may[8] or may not[9] be similar in accuracy.

Predicting death from any infection

A cohort study of patients with any type of infection (half of the patients had pneumonia), the risk of death increases as the score increases[3]:

  • 0 to 1 <5% mortality
  • 2 to 3 < 10% mortality
  • 4 to 5 15-30% mortality

References

  1. McNally M, Curtain J, O'Brien KK, Dimitrov BD, Fahey T (2010). "Validity of British Thoracic Society guidance (the CRB-65 rule) for predicting the severity of pneumonia in general practice: systematic review and meta-analysis.". Br J Gen Pract 60 (579): e423-33. DOI:10.3399/bjgp10X532422. PMID 20883616. PMC PMC2944951. Research Blogging.
  2. Lim WS, van der Eerden MM, Laing R, et al (2003). "Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study". Thorax 58 (5): 377-82. PMID 12728155[e]
  3. 3.0 3.1 Howell MD, Donnino MW, Talmor D, Clardy P, Ngo L, Shapiro NI (2007). "Performance of severity of illness scoring systems in emergency department patients with infection". Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 14 (8): 709-14. DOI:10.1197/j.aem.2007.02.036. PMID 17576773. Research Blogging.
  4. Lim WS, Macfarlane JT, Boswell TC, et al (2001). "Study of community acquired pneumonia aetiology (SCAPA) in adults admitted to hospital: implications for management guidelines". Thorax 56 (4): 296-301. PMID 11254821[e]
  5. (2001) "BTS Guidelines for the Management of Community Acquired Pneumonia in Adults". Thorax 56 Suppl 4: IV1-64. PMID 11713364[e]
  6. Chen JH, Chang SS, Liu JJ, Chan RC, Wu JY, Wang WC et al. (2010). "Comparison of clinical characteristics and performance of pneumonia severity score and CURB-65 among younger adults, elderly and very old subjects.". Thorax 65 (11): 971-7. DOI:10.1136/thx.2009.129627. PMID 20965934. Research Blogging.
  7. Myint PK, Sankaran P, Musonda P, Subramanian DN, Ruffell H, Smith AC et al. (2009). "Performance of CURB-65 and CURB-age in community-acquired pneumonia.". Int J Clin Pract 63 (9): 1345-50. DOI:10.1111/j.1742-1241.2009.02147.x. PMID 19691619. Research Blogging.
  8. Ochoa-Gondar O, Vila-Corcoles A, Rodriguez-Blanco T, Ramos F, de Diego C, Salsench E et al. (2011). "Comparison of three predictive rules for assessing severity in elderly patients with CAP.". Int J Clin Pract 65 (11): 1165-72. DOI:10.1111/j.1742-1241.2011.02742.x. PMID 21951687. Research Blogging.
  9. Aujesky D, Auble TE, Yealy DM, et al (2005). "Prospective comparison of three validated prediction rules for prognosis in community-acquired pneumonia". Am. J. Med. 118 (4): 384-92. DOI:10.1016/j.amjmed.2005.01.006. PMID 15808136. Research Blogging.

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