CURB-65 and CRB-65

The CURB-65 score is a clinical prediction rule used to assess the severity of community-acquired pneumonia (CAP) and guide decisions about the most appropriate site (home, hospital ward, or intensive care unit) for treatment. The score is calculated based on the presence of five clinical criteria. For each criterion that is present, one point is awarded.

In Australia, the SMART-COP scoring system is preferred. Confusion, RR and BP are common to both, but SMART-COP includes septic markers (tachycardia, acidosis and hypoxia) as well as CXR findings and albumin. As such, SMART-COP is more applicable to DEM than GP.

CURB-65 Criteria:

  1. C – Confusion of new onset (defined as an abbreviated mental test score of 8 or less; a common quick test is to ask the time and age of the patient).
  2. U – Blood Urea Nitrogen (BUN) > 7 mmol/L (20 mg/dL).
  3. R – Respiratory rate ≥ 30 breaths per minute.
  4. B – Blood pressure: Systolic < 90 mmHg or Diastolic ≤ 60 mmHg.
  5. 65 – Age ≥ 65 years.

Scoring and Management Recommendations:

  • Score 0-1: Consider treatment at home or a short inpatient hospitalization.
  • Score 2: Hospitalization is advised due to moderate risk.
  • Score 3-5: Severe pneumonia; consider admitting to the intensive care unit, especially with scores of 4-5.

It’s important to note that the CURB-65 score is a guideline and not an absolute determinant of a patient’s management. Clinical judgment, overall patient condition, and additional factors not captured by the CURB-65 score (e.g., comorbidities, home support system) should always play a role in management decisions.

CRB-65

CRB-65 is a simplified version of the CURB-65 score, which is used to assess the severity of community-acquired pneumonia (CAP). The CRB-65 score omits the laboratory criterion (Urea/BUN) from CURB-65, making it useful in settings where lab results might not be immediately available, such as primary care.

CRB-65 Criteria:

  1. C – Confusion of new onset.
  2. R – Respiratory rate ≥ 30 breaths per minute.
  3. B – Blood pressure: Systolic < 90 mmHg or Diastolic ≤ 60 mmHg.
  4. 65 – Age ≥ 65 years.

For each criterion present, one point is awarded.

Scoring and Management Recommendations:

  • Score 0: Low risk; consider home treatment.
  • Score 1-2: Intermediate risk; consider hospitalization or close outpatient follow-up.
  • Score 3-4: High risk; hospital admission and potential intensive care is advisable.

As with CURB-65, the CRB-65 score is a guideline to assist in clinical decision-making, but it’s not an absolute determinant. The overall clinical picture, other comorbid conditions, and factors not captured by the CRB-65 should be taken into consideration when determining the best management approach for a patient with CAP.