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CURB-65 Score Calculator: A tool for Assessing Pneumonia Severity

CURB-65 Score

The CURB-65 and CRB-65 scores are clinical scoring systems used to assess the severity and predict the mortality risk in patients with community-acquired pneumonia (CAP). These scores help healthcare professionals make decisions regarding the need for hospitalization and the level of care required for a patient with pneumonia.

  1. CURB-65 Score:

    The CURB-65 score evaluates five clinical parameters:

    • Confusion: Assessing the mental status of the patient.
    • Urea: Measuring the blood urea nitrogen level.
    • Respiratory Rate: Evaluating the breathing rate.
    • Blood Pressure: Determining the systolic blood pressure.
    • Age: Considering the age of the patient.

    Each parameter is assigned a score of 0 or 1, with 0 indicating a lower severity and 1 indicating a higher severity. The scores are summed, resulting in a total score ranging from 0 to 5. The higher the score, the greater the severity of pneumonia and the higher the mortality risk. The CURB-65 score can help guide decisions on whether to hospitalize a patient or provide outpatient treatment.

    CURB-65 Score Interpretation:
    • Score of 0-1: Low severity, suitable for outpatient treatment.
    • Score of 2: Intermediate severity, consider hospitalization or closely monitor as an outpatient.
    • Score of 3-5: High severity, generally indicates the need for hospitalization.
  2. CRB-65 Score:

    The CRB-65 score is a simplified version of the CURB-65 score, focusing on three parameters:

    • Confusion: Assessing the mental status of the patient.
    • Respiratory Rate: Evaluating the breathing rate.
    • Blood Pressure: Determining the systolic blood pressure.

    Similar to the CURB-65 score, each parameter is assigned a score of 0 or 1, and the scores are summed to obtain a total score ranging from 0 to 3. The higher the score, the higher the severity and mortality risk associated with pneumonia. The CRB-65 score is often used as a quicker alternative to the CURB-65 score.

    CRB-65 Score Interpretation:
    • Score of 0: Low severity, suitable for outpatient treatment.
    • Score of 1-2: Intermediate severity, consider hospitalization or closely monitor as an outpatient.
    • Score of 3: High severity, generally indicates the need for hospitalization.

Both the CURB-65 and CRB-65 scores provide valuable information to healthcare professionals when assessing the severity of community-acquired pneumonia and determining appropriate treatment strategies. However, it's important to note that these scores are not the sole determining factors, and clinical judgment should always be exercised in the management of individual patients.

Last update: 21 Jun 2023 00:54
Risk estimates extrated from studies found in the Thorax [1] and Academic Emergency Medicine [2] publications.
Recommendations based on score

It's important to note that the CURB-65 score can also be utilized to assess the severity of various other types of infections, alongside other scores such as sepsis severity scores (SSS, SOFA, qSOFA, MODS, etc.). These additional scores are specifically designed to evaluate the severity and progression of sepsis, a potentially life-threatening condition resulting from an infection.

By incorporating multiple scoring systems, healthcare professionals can obtain a more comprehensive assessment of the patient's condition, aiding in the decision-making process and determining appropriate treatment strategies for various infectious diseases.

Overview of the CURB-65 CAP Score

The available literature shows that extensive research was done to assess the performance of the CURB-65 score, which has been utilized extensively to predict ICU admissions and mortality rates in patients with community-acquired pneumonia (CAP). This scoring system demonstrates several notable characteristics (and some limitations): [1], [2]

  1. It demonstrates a very high sensitivity of 78.4% for ICU admissions and 92.8% for mortality prediction. However, it has shown low specificity, as patients with low scores (≤2) are still frequently admitted to the ICU. One study reported an area under the curve (AUC) of 0.73-0.77, with mortality rates of 0.6% for a score of 0-1, 5.7% for a score of 2, and 12.8% for a score of 3-5. [3]

  2. Another study comparing the CURB-65 score to the NEWS score, involving 570 CAP patients with a median age of 74, found that the CURB-65 score had a good discriminatory power with an AUC of 0.728, similar to the NEWS score (0.710), with no statistical difference between them. [4]

  3. The CURB-65 score has shown associations with both 30-day mortality rates and the need for mechanical ventilation. In addition, there are no significant statistical differences between the CURB-65 score and the simpler CRB-65 score. Both scores exhibit very similar AUC values at 0.870 and 0.864, respectively, for predicting 30-day mortality rates. [5]

    A study noted that patients with a CURB-65 score of 2 could be further categorized into two groups with statistically different mortality rates based on the PSI risk class: Classes I-III had a 2.6% 30-day mortality, while PSI classes IV-V had an 11.1% mortality rate. For scores greater than or equal to 3, the majority of patients (92.6%) fell into PSI risk classes IV-V, and the mortality rate in this group was 28.5%. These conclusions were drawn from a prospective study involving 1776 patients over approximately four years. [5]

  4. A study conducted in 2020 on 279 patients with COVID-19 showed that a high CURB-65 score (≥3) was strongly associated with poor outcomes, with hazard ratios of 1.84 for a score of 2 and 4.18 for a score of ≥3. Notably, 21.1% of patients with a score of 0-1 still experienced poor outcomes, indicating the score's low specificity, particularly in the context of COVID-19. [6]

  5. In a study comparing the CURB-65 score to the PSI risk score in 408 cases of CAP, the PSI risk score demonstrated higher sensitivity and specificity than the CURB-65 score. The PSI score was a better predictor of 30-day mortality at high scores (PSI IV-V) and ICU admissions at low scores (PSI I-II), albeit with increased diagnostic complexity. The authors emphasized the need for a new score that maintains relative ease-of-use while providing greater precision than the CURB-65 score. [7]

Conclusion

While the CURB-65 score has proven useful in assessing the severity of CAP, its limitations in terms of specificity and performance in certain contexts, such as COVID-19, highlight the need for further research and the development of improved scoring systems.

Attention

A study done in 2006 on over 1700 CAP cases noted that patients with a CURB-65 score of 2 could be further categorized into two groups with statistically different mortality rates based on the PSI risk class: Classes I-III had a 2.6% 30-day mortality, while PSI classes IV-V had an 11.1% mortality rate. For scores greater than or equal to 3, the majority of patients (92.6%) fell into PSI risk classes IV-V, and the mortality rate in this group was 28.5%. [5]

Always strive to collect comprehensive clinical information and historical data, enabling you to make informed decisions based on imaging findings, symptoms, and treatment response. If a CAP patient's clinical condition worsens, never hesitate to seek specialized assistance from pneumologists, infectious diseases specialists, or anesthesiologists. It's crucial to anticipate such events whenever possible rather than relying solely on a single risk score or clinical finding for patient management decisions.

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Lesson authors: Dr. Mironescu Olivier, Dr. Huțuleac Oana-Mihaela
Published on: 21 Jun 2023 00:54
Open in mediakronos:
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The CURB-65 and CRB-65 scores are clinical scoring systems used to assess the severity and predict the mortality risk in patients with community-acquired pneumonia (CAP). These scores help healthcare professionals make decisions regarding the need for hospitalization and the level of care required for a patient with pneumonia.

  1. CURB-65 Score:

    The CURB-65 score evaluates five clinical parameters:

    • Confusion: Assessing the mental status of the patient.
    • Urea: Measuring the blood urea nitrogen level.
    • Respiratory Rate: Evaluating the breathing rate.
    • Blood Pressure: Determining the systolic blood pressure.
    • Age: Considering the age of the patient.

    Each parameter is assigned a score of 0 or 1, with 0 indicating a lower severity and 1 indicating a higher severity. The scores are summed, resulting in a total score ranging from 0 to 5. The higher the score, the greater the severity of pneumonia and the higher the mortality risk. The CURB-65 score can help guide decisions on whether to hospitalize a patient or provide outpatient treatment.

    CURB-65 Score Interpretation:
    • Score of 0-1: Low severity, suitable for outpatient treatment.
    • Score of 2: Intermediate severity, consider hospitalization or closely monitor as an outpatient.
    • Score of 3-5: High severity, generally indicates the need for hospitalization.
  2. CRB-65 Score:

    The CRB-65 score is a simplified version of the CURB-65 score, focusing on three parameters:

    • Confusion: Assessing the mental status of the patient.
    • Respiratory Rate: Evaluating the breathing rate.
    • Blood Pressure: Determining the systolic blood pressure.

    Similar to the CURB-65 score, each parameter is assigned a score of 0 or 1, and the scores are summed to obtain a total score ranging from 0 to 3. The higher the score, the higher the severity and mortality risk associated with pneumonia. The CRB-65 score is often used as a quicker alternative to the CURB-65 score.

    CRB-65 Score Interpretation:
    • Score of 0: Low severity, suitable for outpatient treatment.
    • Score of 1-2: Intermediate severity, consider hospitalization or closely monitor as an outpatient.
    • Score of 3: High severity, generally indicates the need for hospitalization.

Both the CURB-65 and CRB-65 scores provide valuable information to healthcare professionals when assessing the severity of community-acquired pneumonia and determining appropriate treatment strategies. However, it's important to note that these scores are not the sole determining factors, and clinical judgment should always be exercised in the management of individual patients.

CURB-65, CRB-65, clinical scoring system, severity assessment, mortality risk, community-acquired pneumonia, CAP, healthcare professionals, hospitalization, outpatient treatment, clinical parameters, confusion, urea, respiratory rate, blood pressure, age, score interpretation, low severity, intermediate severity, high severity, decision-making, management, clinical judgment.CURB-65 Score Calculator: A tool for Assessing Pneumonia SeverityCURB-65 Score0000
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