Pneumonia Severity Scores: CURB-65

[Mr. Nine]

CURB-65

Pneumonia Severity Scores

Lim WS et. al. Thorax 2003; 58: 377-382


Score
C Confusion 1
U Urea >7 mmol/L 1
R Resp. ≥ 30 1
BP Syst. ≤90mmHg or
Diast. ≤60 1
65 yr Age > 65 yr. 1


CURB-65
Score Risk group 30-day mortality Management
0-1 1 1.5% Home
2 2 9.2% Likely to need
admission
3-5 3 22% Admit. Manage as
severe.

[Mr. Nine]

A recent study by Buising and colleagues was the first to compare five
well-known pneumonia severity scores: the Pneumonia Severity Index
(PSI), CURB, CURB-65, the modified British Thoracic Society (BTS)
score, and the revised American Thoracic Society (ATS) score.1

"The results show that different severity scores for community-
acquired pneumonia have different strengths and weaknesses depending
on which patients the clinician really wants to identify," the authors
reported. The CURB-65 score, for example, accurately predicted
mortality but not the need for ICU admission or the combination of
those outcomes. The revised ATS score was a sensitive predictor of ICU
admission but not death. The PSI performed reasonably well in all
areas, and the CURB score was similar in accuracy to the PSI, said the
authors.

"The existing severity scores have been derived using predictors of
mortality, so constructs to represent ‘severe pneumonia’ rather than
just ‘pneumonia leading to death’ needed to be looked at," principal
author Kirsty L. Buising, MD, told Pulmonary Reviews. "That is why we
tested severity scores for their value in predicting more clinically
meaningful outcomes," explained Dr. Buising, a Clinical Research
Fellow in the Victorian Infectious Diseases Service at Melbourne
Hospital in Victoria, Australia.

The five scores were evaluated in a prospective cohort of 392 patients
hospitalized with a diagnosis of community-acquired pneumonia.

Of the patients, 6.6% were admitted to the ICU and 9.4% died.
Excluding those who were not treated with antibiotics or who had
suspected aspiration pneumonia, 36% did not receive a recommended
antibiotic regimen.

For predicting mortality, the combination of PSI classes IV and V was
most sensitive (97.3%) but the least specific (47.9%). The revised ATS
score was most specific (84.6%) but the least sensitive (40.5%). At
96%, the modified BTS score was the most sensitive predictor of ICU
admission but it was also the least specific for that outcome (48.7%).
The revised ATS score was most specific (87.3%) and the second-most
sensitive (92%) for predicting ICU admission.

—Timothy Began

Credit: PNEUMONIA SEVERITY SCORES—WHICH ARE BEST?
http://www.pulmonaryreviews.com/jul06/pneumonia.html