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CURB-65 Score

Assess severity of community-acquired pneumonia (CAP) to guide disposition: outpatient treatment, hospital admission, or ICU-level care.

Inputs

Confusion (new mental confusion)

Urea > 7 mmol/L (BUN > 19 mg/dL)

Respiratory rate ≥ 30/min

Blood pressure: SBP < 90 or DBP ≤ 60 mmHg

Age ≥ 65 years

CURB-65 Score (0–5)

Low severity

30-day mortality—

Disposition—

Disclaimer: For educational purposes only. Not a substitute for clinical judgment. Consider comorbidities, social factors, and oxygenation status in disposition decisions.

Scoring

Confusion — new disorientation (person, place, time) +1
Urea > 7 mmol/L (BUN > 19 mg/dL) +1
Respiratory rate ≥ 30/min +1
Blood pressure — SBP < 90 or DBP ≤ 60 mmHg +1
Age ≥ 65 +1

Mortality & disposition

0–1: ~1.5% mortality → Outpatient treatment likely appropriate
2: ~9.2% mortality → Consider short inpatient stay or closely supervised outpatient
3–5: ~22% mortality (score 3), up to 57% (score 5) → Hospital admission; score ≥ 4 consider ICU

Clinical pearls

Validated for community-acquired pneumonia, not hospital-acquired or ventilator-associated.
CRB-65 (without urea) can be used in outpatient settings where labs are unavailable.
Always assess oxygenation (SpO₂, PaO₂) separately — hypoxia alone may warrant admission regardless of score.
Consider social factors (ability to take oral medications, reliable follow-up).

References

Lim WS, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003;58(5):377–382.
BTS Guidelines for the management of community acquired pneumonia in adults (2009 update).