CURB-65 Score Calculator

CURB-65 Score

Community-acquired pneumonia severity assessment tool

Confusion

New onset confusion or disorientation

Urea > 7 mmol/L

Blood urea nitrogen > 19 mg/dL

Respiratory Rate ≥ 30/min

Respiratory rate of 30 breaths per minute or higher

Blood Pressure (SBP < 90 or DBP ≤ 60 mmHg)

Systolic BP < 90 mmHg or diastolic BP ≤ 60 mmHg

Age ≥ 65 years

Patient is 65 years of age or older

Risk Stratification

0-2 points: Low risk (0.6-6.8% mortality) - Consider outpatient treatment
3 points: Moderate risk (14.0% mortality) - Consider hospital admission
4-5 points: Severe risk (27.8% mortality) - Hospital admission recommended

CURB-65 Score Calculator

The CURB-65 score is a validated clinical prediction rule for assessing the severity of community-acquired pneumonia (CAP) and predicting 30-day mortality risk. It helps guide decisions regarding hospital admission and level of care.

Components of CURB-65

The score is calculated by assigning 1 point for each of the following criteria:

C - Confusion: New onset confusion or disorientation
U - Urea > 7 mmol/L: Blood urea nitrogen > 19 mg/dL
R - Respiratory rate ≥ 30/min: Respiratory rate of 30 breaths per minute or higher
B - Blood pressure: Systolic BP < 90 mmHg or diastolic BP ≤ 60 mmHg
65 - Age ≥ 65 years: Patient is 65 years of age or older

Risk Stratification

Low Risk (0-2 points)

0 points: 0.6% 30-day mortality - Consider outpatient treatment
1 point: 2.7% 30-day mortality - Consider outpatient treatment
2 points: 6.8% 30-day mortality - Consider outpatient treatment

Moderate Risk (3 points)

3 points: 14.0% 30-day mortality - Consider hospital admission

Severe Risk (4-5 points)

4 points: 27.8% 30-day mortality - Hospital admission recommended
5 points: 27.8% 30-day mortality - Hospital admission required, consider ICU

Clinical Applications

Outpatient vs. Inpatient Decision

Low risk (0-2 points): Generally safe for outpatient treatment with appropriate follow-up
Moderate risk (3 points): Consider hospital admission, especially if comorbidities present
Severe risk (4-5 points): Hospital admission recommended, consider ICU for 5 points

Treatment Considerations

Antibiotic selection: May influence choice of empiric therapy
Monitoring intensity: Higher scores require closer monitoring
Discharge planning: Lower scores may allow earlier discharge
Follow-up: Higher scores require more frequent follow-up

Important Considerations

Limitations

Not validated for healthcare-associated pneumonia
May underestimate severity in immunocompromised patients
Does not account for comorbidities or social factors
Should be used in conjunction with clinical judgment

Additional Factors to Consider

Comorbidities: COPD, heart failure, diabetes, chronic kidney disease
Social factors: Homelessness, substance abuse, poor access to care
Clinical presentation: Severity of symptoms, ability to maintain oral intake
Laboratory findings: Leukopenia, thrombocytopenia, elevated liver enzymes
Radiographic findings: Multilobar involvement, pleural effusion

Comparison with Other Scores

CURB-65 vs. PSI (Pneumonia Severity Index)

CURB-65: Simpler, easier to calculate at bedside
PSI: More complex but may be more accurate for low-risk patients
Clinical use: CURB-65 preferred for rapid assessment

CURB-65 vs. CRB-65

CRB-65: Excludes urea measurement, useful in primary care
CURB-65: More accurate but requires laboratory testing

Clinical Pearls

Always use clinical judgment in addition to the score
Consider patient preferences and social circumstances
Monitor for clinical deterioration regardless of initial score
Reassess severity if patient condition changes
Use in conjunction with other clinical findings and laboratory results

This calculator provides a quick and validated method for assessing CAP severity and guiding treatment decisions. The CURB-65 score is widely used in clinical practice and has been validated in multiple populations.

References

Lim, W. S., van der Eerden, M. M., Laing, R., Boersma, W. G., Karalus, N., Town, G. I., ... & Macfarlane, J. T. (2003). Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax, 58(5), 377-382.
National Institute for Health and Care Excellence. (2014). Pneumonia in adults: diagnosis and management. Clinical guideline [CG191].
Metlay, J. P., Waterer, G. W., Long, A. C., Anzueto, A., Brozek, J., Crothers, K., ... & Whitney, C. G. (2019). Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. American Journal of Respiratory and Critical Care Medicine, 200(7), e45-e67.
Fine, M. J., Auble, T. E., Yealy, D. M., Hanusa, B. H., Weissfeld, L. A., Singer, D. E., ... & Kapoor, W. N. (1997). A prediction rule to identify low-risk patients with community-acquired pneumonia. New England Journal of Medicine, 336(4), 243-250.
Ewig, S., de Roux, A., Bauer, T., García, E., Mensa, J., Niederman, M., & Torres, A. (2004). Validation of predictive rules and indices of severity for community acquired pneumonia. Thorax, 59(5), 421-427.

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