Diagnosis and Assessment of Disease
Table 1A. CURB-65 Severity Scores for CAP Clinical Factors
Confusion
Blood urea nitrogen > 20 mg/dL Respiratory rate ≥ 30 breaths/min
Systolic blood pressure < 90 mm Hg or diastole ≤ 60 Age > 65 Years
Total Points:
CURB-65 Score 0 1 2 3
4 or 5
Deaths (%)* 0.6 2.7 6.8
14.0 27.8
Recommendations†
Low risk; consider home treatment Low risk; consider home treatment Admit to ward
Severe pneumonia; hospitalize and consider admitting to intensive care
CURB-65 = Confusion, Urea Nitrogen, Respiratory rate, Blood pressure, 65 years of age and older. *Data are weighted averages from validation studies. †Recommendations are consistent with British Thoracic Society guidelines. Clinical judgment may overrule guideline recommendations.
Points 1 1 1 1 1
Table 2. Criteria for Severe Community-Acquired Pneumonia
Minor Criteriaa Respiratory rateb PaO2/FiO2 ratiob
≥ 30 breaths/min < 250
Multilobar infiltrates Confusion/disorientation Uremia (BUN level > 20 mg/dL) Leukopeniac
(WBC count < 4000 cells/mm3
) Thrombocytopenia (platelet count < 100,000 cells/mm3
Hypothermia (core temperature < 36°C) Hypotension requiring aggressive fluid resuscitation Major Criteria Invasive mechanical ventilation Septic shock with the need for vasopressors BUN, blood urea nitrogen; PaO2
blood cell. a
/FiO2 )
, arterial oxygen pressure/fraction of inspired oxygen; WBC, white
b A need for noninvasive ventilation can substitute for a respiratory rate >30 breaths/min or a PaO2 ratio < 250.
c As a result of infection alone.
Other criteria to consider include hypoglycemia (in nondiabetic patients), acute alcoholism/alcoholic withdrawal, hyponatremia, unexplained metabolic acidosis or elevated lactate level, cirrhosis, and asplenia.
/FiO2
