Scoring and risk stratification (part 4)

Hello again and Happy New Year! I hope this year brings you new challenges and much joy. This week, another scoring tool will be shared. It is called the ”Curb65” rule. It sounds like a really catchy weight loss program for the New Year, don’t you think? In fact, it is a scoring tool for determining the 30-day mortality risk of patient’s presenting to hospital with a community acquired pneumonia. The link for the original article for the Curb65 rule’s validation is below. Here are the 5 criteria for CURB65:

C = Confusion (new onset)

U = Urea (i.e. blood urea nitrogen) > 7 mmol/L

R = Respiratory rate > 30

B = Blood pressure < 90 mm Hg systolic or < 60 mmHg diastolic

65 = Age > 65

 Each criteria is 1 point. Here is the details of the scoring system:

– A score of 0 or 1 has a low mortality risk (1.5%) and is likely suitable for home management.

– A score of 2 has a intermediate mortality risk (9.2%) and should be considered for hospital management (e.g. short stay or close outpatient follow-up)

– A score of 3 or more has a high mortality risk (22%) and should be managed in-hospital and considered for ICU management if the score is 4 or 5.

 If you do not have access to blood chemistry and are in a community clinic, you may alternatively use the CRB65 score. This is the same criteria as the CURB65, but conveniently only includes the clinical criteria. Again, it predicts 30-day mortality. Here is the scoring system for CRB65:

Each criteria is 1 point

– A score of has a low mortality risk (1.2%) and is likely suitable for home management.

– A score of 1 or 2 has an intermediate mortality risk (8.15%) and should be considered for hospital assessment/referral.

– A score of 3 or 4 has a high mortality risk (31%) and should be managed in-hospital and needs urgent hospital assessment.


Click here to consult the original article by Lim et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study.

*Note: this tool (and other risk stratification tools posted on this blog) is only for use by medical professionals in the medical context. If you are concerned for your health, please consult your physician!

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