How is the CURB-65 score interpreted?

Score 0–1: Low risk (~1.5% mortality), consider outpatient treatment. Score 2: Moderate risk (~9% mortality), consider short inpatient stay or closely supervised outpatient care. Score 3–5: High risk (15–40% mortality), hospitalize; score ≥ 4 consider ICU admission.

CRB-65 omits the Urea criterion (BUN), making it suitable for outpatient settings where labs are unavailable. Score 0: Very low risk, outpatient management. Score 1–2: Increased risk, consider referral. Score 3–4: High risk, urgent hospital admission. It has similar predictive performance to CURB-65.

How does CURB-65 compare to the PSI/PORT score?

CURB-65 is simpler (5 variables) but may miss some low-risk patients that PSI/PORT identifies. PSI/PORT uses 20 variables and better identifies low-risk patients safe for outpatient management. CURB-65 is preferred in emergency settings for its simplicity; PSI/PORT is preferred when the goal is to identify candidates for outpatient treatment.

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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.

Eingaben

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—

Haftungsausschluss: Nur zu Bildungszwecken. Kein Ersatz für klinisches Urteil. Consider comorbidities, social factors, and oxygenation status in disposition decisions.

Bewertung

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).

Related tools

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What Is the CURB-65 Score?

CURB-65 is a clinical prediction rule for assessing the severity of community-acquired pneumonia (CAP) and guiding disposition decisions. Developed by Lim et al. in 2003 based on a large derivation and validation cohort from the British Thoracic Society, it uses five easily assessed variables: Confusion, Urea >7 mmol/L (BUN >19 mg/dL), Respiratory rate ≥30/min, Blood pressure (SBP <90 or DBP ≤60), and age ≥65. Each criterion scores one point for a total of 0–5.

When to Use CURB-65

Calculate CURB-65 at presentation for all patients with suspected or confirmed community-acquired pneumonia to determine the appropriate level of care. It helps answer the key clinical question: can this patient be safely treated as an outpatient, or do they need hospital admission (and potentially ICU care)? CRB-65 (without urea) can be used in primary care or resource-limited settings where blood tests are not immediately available.

Interpreting CURB-65 Results

Scores of 0–1 indicate low severity with 30-day mortality ~1.5%, suitable for outpatient management. A score of 2 (~9.2% mortality) suggests short inpatient stay or close outpatient supervision. Scores of 3–5 indicate severe pneumonia with mortality ranging from 14.5% to 57%, warranting hospital admission and ICU consideration for scores ≥4.

🔑 Klinische Hinweise

CURB-65 was validated for CAP only — do not use for hospital-acquired, ventilator-associated, or aspiration pneumonia.
Always assess oxygenation (SpO₂) separately. A patient with CURB-65 of 0 but SpO₂ <92% on room air may still need admission.
Social factors matter: inability to take oral medications, unreliable follow-up, unstable housing, or inability to self-care may warrant admission regardless of score.
The Pneumonia Severity Index (PSI/PORT) is an alternative that uses 20 variables and may better identify low-risk patients, but CURB-65 is faster and simpler for bedside use.

Schlüsselreferenzen

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: Update 2009. Thorax. 2009;64(Suppl III):iii1–iii55.
Metlay JP, et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia: An Official ATS/IDSA Clinical Practice Guideline. Am J Respir Crit Care Med. 2019;200(7):e45–e67.

Formel zuletzt überprüft: Februar 2026