Community-Acquired Pneumonia — Initial Presentation
Fever, productive cough, pleuritic pain prompt severity assessment.
- ~5–6/1000: CAP annual incidence (adults, developed nations)
- ~20%: Hospitalization rate (of diagnosed CAP cases)
- S. pneumoniae: Common pathogen (most frequent cause)
- 5: Score components (C · U · R · B · 65)
Why triage matters early
Early severity scoring guides safe, efficient treatment setting.
CURB-65 origin
Derived and validated across large UK cohort studies.
A simple bedside tool, no labs strictly required.
Assessing the Five CURB-65 Criteria
Each criterion is scored as one point, present or absent.
- AMT ≤8: Confusion test (abbreviated mental test)
- >7 mmol/L: Urea threshold (≈ BUN 19 mg/dL)
- ≥30/min: Resp. rate cutoff (tachypnea marker)
- SBP<90/DBP≤60: BP cutoff (hypotension marker)
Confusion & mental status
New disorientation signals systemic severity, not baseline dementia.
Urea and vitals
Renal stress and hemodynamic compromise both raise risk.
Each toggled criterion adds exactly one point.
Computing the Score in Real Time
Score sums to a single integer from 0 through 5.
- 0–5: Score range (integer points)
- 0.6%: Score 0 mortality (lowest risk tier)
- 14.0%: Score 3 mortality (high risk tier)
- 27.8%: Score 5 mortality (highest risk tier)
Additive point system
No weighting — each criterion contributes equally, one point.
Mortality correlation
Higher scores track closely with 30-day mortality data.
Score updates instantly as sliders move.
Mapping Score to Disposition Pathway
Score bands route patients to home, ward, or ICU.
- Outpatient: Score 0–1 (low-risk pathway)
- Consider admit: Score 2 (moderate-risk pathway)
- Hospitalize: Score 3–5 (high-risk pathway)
- Consider ICU: Score ≥3 (severe pathway)
Gauge dial logic
Needle sweeps from home zone to ward to ICU.
Clinical judgment
Score guides, but never fully replaces bedside judgment.
Score ≥3 always prompts ICU-readiness review.
Appropriate Triage vs. Under-Triage Risk
Correct disposition reduces avoidable mortality and readmission.
- ↑ mortality: Under-triage risk (delayed escalation of care)
- ↓ length of stay: Appropriate triage (right level, first time)
- worse outcomes: ICU delay effect (sepsis progression window)
- widespread: Tool adoption (guideline-endorsed worldwide)
Consequences of under-triage
Sending a high-score patient home risks rapid deterioration.
Consequences of over-triage
Unnecessary admission strains beds and inflates costs.
CURB-65 balances safety against resource use.