Curb-65
Info
Confusion / Disorientation Yes No
BUN level >20 mg/dL (Urea >7 mmol/L) Yes No
Respiratory rate > or equal to 30/min Yes No
Blood pressure Systolic <90 mmHg OR Diastolic <60 mmHg Systolic >90 mmHg OR Diastolic >60 mmHg
Age > or equal to 65 years Yes No
R e s u l t s
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Score
 
Mortality Rate
 
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Curb-65

The CURB-65 (Confusion, Uremia, Respiratory Rate, Blood Pressure, Age >= 65 years) is one of 2 recommended scores for use with current guidelines for Community Acquired Pneumonia (CAP) published in 2007 through the joint efforts of both the Infectious Diseases Society of America and the American Thoracic Society.

This modification of BTS Criteria, found the 5 factors to be a quick and accurate method of assessment of degree of illness and risk of mortality in patients with CAP.

The 5 factors are:

  • Confusion / Disorientation
  • BUN level >20 mg/dL (Urea >7 mmol/L)
  • Respiratory rate >=30/min
  • Blood pressure low
    • Systolic<90 mmHg OR
    • Diastolic<60 mmHg
  • Age >= 65 years

30 Day Mortality

# of Factors Present Rate of Mortality
0 0.7%
1 2.1%
2 9.2%
3 14.5%
4 40%
5 57%

2007 CAP Guidelines are indicating need for inpatient admission vs. outpatient treatment based upon:

  • Clinical judgement
  • Pneumonia Severity Index (PSI) OR CURB-65 Scoring (Both of which are present in Archimedes)
  • CURB-65 scores
    • 0-1 = Usually treated as outpatient
    • 2 = Admission to medical ward
    • >=3 = Usually ICU admission
  • PSI scores
    • Risk groups I and 2 (<51 points and 51-70 points respectively) = Usually treated as outpatient
    • Risk group III (71-90 points) may require observation admission
    • Risk groups IV/V (90-130 and >130 points respectively) should be admitted

Need for ICU Admission should be strongly considered if 1 major criterion or >3 minor criterion are present:

Major Criteria

  • Patient mechanically ventilated
  • Septic Shock present

Minor Criteria

  • Respiratory rate>30/min
  • Arterial oxygen pressure/fraction of inspired oxygen (PaO2/FiO2) ratio<250
  • Multilobar infiltrates
  • Confusion
  • BUN>20 mg/dL
  • Leukopenia (believed due to infection)
  • Thrombocytopenia
  • Hypothermia
  • Hypotension requiring aggressive fluid resuscitation

References:

Capelastegui A, et al. Validation of a predictive rule for the management of community-acquired pneumonia. Eur Respir J 2006;27:151-7.

Fine MJ, et al. A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 1997;336:243-50.

Lim WS, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 2003;58:377-82.

The Infectious Diseases Society of America/American Thoracic Society Consensus Guidelines on the Management of Community-Acquired Pneumonia in Adults. Clin Infect Dis. 2007;44 [Suppl 2]:S27-72.

Available online at: http://www.journals.uchicago.edu/CID/journal/issues/v44nS2/41620/41620.html