Expansion
Confusion, Urea, Respiratory rate, Blood pressure, age 65
Expansion
CURB-65, one point each:
- C - Confusion, an abbreviated mental test score of 8 or less, or new disorientation
- U - Urea above 7 mmol/l
- R - Respiratory rate 30 or more
- B - Blood pressure: systolic under 90 or diastolic 60 or less
- 65 - age 65 or over
Interpretation
| Score | Mortality | Management |
|---|---|---|
| 0 to 1 | Under 3 per cent | Home, oral antibiotics |
| 2 | About 9 per cent | Hospital, consider short stay |
| 3 or more | 15 to 40 per cent | Admit, consider critical care |
CRB-65 omits the urea and is used in primary care: 0 means home, 1 or 2 means refer, 3 or more means urgent admission.
The score is a guide, not a substitute for judgement: it underestimates severity in the young, who compensate well, and it does not measure hypoxia or comorbidity, both of which independently predict a worse outcome.
Atypical organisms to consider alongside: Mycoplasma (young, erythema multiforme, cold agglutinins), Legionella (hyponatraemia, deranged liver tests, air conditioning), Chlamydia psittaci (birds), and Coxiella (farm animals).