CURB-65

A clinical prediction rule for assessing the severity of pneumonia

CURB-65
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Synonyms	N/A
Pronounce	N/A
Specialty	N/A
Symptoms	Confusion, Urea > 7 mmol/L, Respiratory rate ≥ 30/min, Blood pressure < 90 mmHg systolic or ≤ 60 mmHg diastolic, Age ≥ 65 years
Complications	Severe pneumonia, Sepsis
Onset	N/A
Duration	N/A
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Risks
Diagnosis	Clinical prediction rule
Differential diagnosis	N/A
Prevention	N/A
Treatment
Medication	N/A
Prognosis
Frequency
Deaths	N/A

CURB-65 is a clinical prediction rule that has been validated for predicting mortality in community-acquired pneumonia and infection of any site. It is used to assess the severity of pneumonia and to help determine whether patients should be treated as outpatients or require hospitalization.

Components

The CURB-65 score is calculated based on five criteria, each of which scores one point:

1. Confusion: New onset confusion (defined as an Abbreviated Mental Test Score of 8 or less, or disorientation to person, place, or time).
2. Urea: Blood urea nitrogen level greater than 7 mmol/L (19 mg/dL).
3. Respiratory rate: 30 breaths per minute or more.
4. Blood pressure: Systolic blood pressure less than 90 mmHg or diastolic blood pressure 60 mmHg or less.
5. Age 65 years or older.

Scoring and Interpretation

The CURB-65 score ranges from 0 to 5, with higher scores indicating greater severity and risk of mortality:

• Score 0-1: Low risk, consider outpatient treatment.
• Score 2: Moderate risk, consider short inpatient stay or close outpatient management.
• Score 3-5: High risk, requires hospitalization and possibly intensive care.

Clinical Use

CURB-65 is widely used in clinical practice due to its simplicity and effectiveness. It helps clinicians make decisions about the level of care required for patients with pneumonia. However, it should be used in conjunction with clinical judgment and other diagnostic tools.

Limitations

While CURB-65 is a useful tool, it has limitations. It does not account for all factors that may influence the severity of pneumonia, such as comorbidities or the presence of multidrug-resistant organisms. It is also less predictive in younger populations.

History

The CURB-65 score was derived from the British Thoracic Society guidelines for the management of community-acquired pneumonia in adults. It was developed to provide a simple and effective method for assessing pneumonia severity.

Also see

• Pneumonia severity index
• Community-acquired pneumonia
• Sepsis
• Abbreviated Mental Test Score