By Michael Spinner
The prognosis and management of community-acquired pneumonia may vary considerably from patient to patient. Some are treated effectively with oral antibiotics in the outpatient setting, others should be hospitalized for IV antibiotics, and the most severe cases may require ICU admission to provide ventilatory and/or hemodynamic support. Use the CURB-65 criteria listed below to help estimate the prognosis and determine the appropriate management for patients with community-acquired pneumonia:
C – Confusion (new change in mental status)
U – Urea >7 mmol/L
R – Respiratory rate ³30
B – Blood pressure <90 systolic or £60 diastolic
65 – Age ³65
The prognosis correlates with the number of criteria met at the time of diagnosis as illustrated in the figure below (Lim et al, Thorax 2003):
The CURB-65 criteria are also useful in determining the appropriate management plan. Patients who meet 0 or only 1 criterion can typically be treated safely with oral antibiotics in the outpatient setting (review this post to learn more about choosing empiric antibiotics for pneumonia). Patients who meet 2 or 3 criteria should typically be admitted to the hospital for IV antibiotics or watched very closely as outpatients. Those who meet 4 or 5 criteria require hospitalization and often ICU-level care including mechanical ventilation and pressors.
Next time you see a patient in clinic or on the wards with pneumonia, try using the CURB-65 criteria. I hope this mnemonic will serve you well!
Lim MW, van der Eerden, Laing R, et al. Defining community-acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003;58(5):377-82.