CURB-65 is a clinical prediction tool widely used to assess the severity of community-acquired pneumonia (CAP) and estimate the risk of 30-day mortality. Developed in 2002 at the University of Nottingham, CURB-65 is a simple and effective scoring system that helps clinicians make informed decisions regarding patient management and care.
What Does CURB-65 Stand For?
The acronym CURB-65 represents five key clinical criteria:
- Confusion: New onset of disorientation or altered mental status.
- Urea: Blood Urea Nitrogen (BUN) > 7 mmol/L (or > 19 mg/dL).
- Respiratory Rate: ā„ 30 breaths per minute.
- Blood Pressure: Systolic < 90 mmHg or Diastolic ā¤ 60 mmHg.
- 65: Age 65 years or older.
Each criterion is assigned 1 point, resulting in a total score ranging from 0 to 5.
CURB-65 Score
CURB-65 Score for Assessing Community-Acquired Pneumonia
The CURB-65 score is a widely used clinical prediction tool for assessing the severity of community-acquired pneumonia (CAP) and estimating the risk of 30-day mortality. It is an acronym representing the following criteria:
CURB-65 Scoring Criteria
Confusion (new onset): 1 point
Urea (BUN > 7 mmol/L or 19 mg/dL): 1 point
Respiratory rate (ā„ 30 breaths/min): 1 point
Blood pressure (systolic < 90 mmHg or diastolic ā¤ 60 mmHg): 1 point
Age ā„ 65 years: 1 point
The total score ranges from 0 to 5, with each criterion assigned one point. The CURB-65 score is used to:
- Assess Severity: Determines the seriousness of CAP.
- Predict Mortality: Higher scores indicate higher 30-day mortality risk.
- Guide Treatment: Helps decide outpatient care, hospital admission, or ICU placement.
For example, scores of 0-1 indicate low risk and suitability for outpatient treatment, while scores of 4-5 suggest high risk and the need for hospital admission, often with ICU consideration.
Clinical Utility of CURB-65
1. Severity Assessment
CURB-65 allows clinicians to quickly determine the severity of CAP, which is crucial for identifying the most appropriate management strategy.
2. Mortality Risk Prediction
The score correlates with the risk of 30-day mortality:
- 0-1 points: Low risk (mortality ~0.7ā3.2%).
- 2 points: Moderate risk (~13% mortality).
- 3-5 points: High risk (mortality ~41.5ā57%).
| Score |
Risk Level |
Mortality (%) |
Treatment Recommendation |
| 0-1 Points |
Low Risk |
0.7ā3.2% ā |
Suitable for outpatient treatment. |
| 2 Points |
Moderate Risk |
~13% ā |
Consider hospital admission or close outpatient monitoring. |
| 3-5 Points |
High Risk |
41.5ā57% ā |
Hospital admission recommended; ICU consideration for higher scores. |
3. Treatment Decision-Making
CURB-65 helps guide patient disposition and care level:
- 0-1 points: Suitable for outpatient treatment.
- 2 points: Consider hospital admission or close outpatient monitoring.
- 3-5 points: Hospital admission is recommended; higher scores may warrant intensive care unit (ICU) consideration.
4. Resource Optimization
By identifying low-risk patients who can be managed as outpatients, CURB-65 helps reduce unnecessary hospital admissions, optimizing healthcare resource utilization.
5. Standardized Approach
CURB-65 provides a consistent framework for CAP assessment, enhancing decision-making across various healthcare settings.
[1] https://www.inanutshell.ch/en/digital-doctors-bag/curb-65-and-crb-65-score/
[2] https://pmc.ncbi.nlm.nih.gov/articles/PMC6443104/
[3] https://pmc.ncbi.nlm.nih.gov/articles/PMC7255987/
[4] https://geekymedics.com/pneumonia/
[5] https://www.nice.org.uk/guidance/qs110/chapter/quality-statement-4-mortality-risk-assessment-in-hospital-using-curb65-score
[6] https://thorax.bmj.com/content/77/Suppl_1/A81.1
[7] https://pmc.ncbi.nlm.nih.gov/articles/PMC3198487/
[8] https://bestpractice.bmj.com/topics/en-gb/3000108/criteria
[9] https://en.wikipedia.org/wiki/CURB-65
