CURB-65 Pneumonia Severity
Estimate community-acquired pneumonia (CAP) severity using the CURB-65 score. Stratify 30-day mortality risk and guide disposition between outpatient, inpatient, and intensive care management.
Based on: BTS 2009
Input
Pulmonary evaluation flow: Severity → Oxygenation → ABG → Postoperative risk
Clinical reasoning
A 52-year-old with suspected pneumonia. Alert and oriented, RR 24/min, BP normal, BUN normal, age < 65.
What is the next best step?
A 78-year-old with fever, cough, and mild confusion. RR 32/min, BP 88/54 mmHg, age ≥ 65.
What is the most appropriate response?
Overview
CURB-65 is a validated severity score for community-acquired pneumonia (CAP). It guides the initial decision on how aggressively to evaluate and manage the patient — from outpatient observation to urgent inpatient care.
Evidence Summary
CURB-65 was developed by Lim et al. (2003) as a simplified bedside rule for predicting 30-day mortality in community-acquired pneumonia. The five criteria — Confusion, Urea, Respiratory rate, Blood pressure, and Age ≥ 65 — each contribute one point, giving a score from 0 to 5.
CURB-65 does not assess oxygenation. SpO₂ and ABG must be evaluated independently. A low CURB-65 score does not exclude hypoxemia, and oxygenation status can override the disposition implied by the score alone.
| Score | Severity | 30-day mortality (approx.) | Suggested approach |
|---|---|---|---|
| 0 | Low | ≈1% | Outpatient may be appropriate |
| 1 | Low | ≈3% | Outpatient if stable; reassess oxygenation |
| 2 | Moderate | ≈9% | Admission should be considered |
| 3 | High | ≈17% | Inpatient; urgent assessment |
| 4 | High | ≈41% | Inpatient; urgent escalation |
| 5 | High | ≈57% | Inpatient; highest urgency |