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Calculate the CURB-65 score (0–5) for adults with suspected community-acquired pneumonia: confusion, urea/BUN, respiratory rate, blood pressure, and age ≥65. Supports CAP disposition teaching with historical mortality bands—pair with oxygenation and antibiotic pathways, not score alone.
Last updated: June 4, 2026
As assessed clinically; often operationalized with abbreviated mental test or similar tools in trials.
U — Urea / nitrogen
2
Moderate risk
Score 2 often prompts short inpatient stay, hospital-supervised outpatient therapy, or enhanced outpatient follow-up depending on stability and comorbidity.
Original cohorts reported approximate 30-day mortality near 0.7%, 9.2%, and 15% for scores 0, 1, and 2, and higher for 3+; modern outcomes vary with vaccination, pathways, and case mix.
Clinical use
CURB-65 aids risk stratification; it does not replace imaging, oxygenation assessment, or institution-specific pathways (e.g. PSI/PORT, SMART-COP). Pregnancy, immunosuppression, and nursing-home pathogens may change management despite a low score.
Default (age 72, BUN 22, stable RR/BP)
2 / 5
Moderate risk
Young adult, normal labs/vitals
0 / 5
Low mortality risk (typical teaching)
Confusion, urea, RR, BP, age
5 / 5
High risk
| Letter | Criterion | Threshold | Teaching note |
|---|---|---|---|
| C | Confusion (new) | Acute confusion / altered mental status (clinical) | Often operationalized with AMT or similar in validation studies |
| U | Urea elevated | Urea >7 mmol/L OR BUN >19 mg/dL | Azotemia may reflect dehydration, sepsis, or CKD—interpret with baseline |
| R | Respiratory rate | ≥30 breaths/min | Count over one full minute when possible |
| B | Blood pressure low | Systolic <90 mmHg OR diastolic ≤60 mmHg | Either limb triggers one point |
| 65 | Age | ≥65 years | One point if patient is 65 or older |
| Score | 30-day mortality (teaching) | Risk | Disposition teaching |
|---|---|---|---|
| 0 | ~0.7% 30-day (derivation cohort) | Low | Outpatient management often appropriate if clinically stable |
| 1 | ~2–3% 30-day (approximate) | Low | Outpatient with close follow-up; consider brief observation per protocol |
| 2 | ~9% 30-day (classic teaching) | Moderate | Short admission or hospital-supervised outpatient therapy common |
| 3 | ~15–17% 30-day | High | Inpatient admission; evaluate ICU need with hypoxia/sepsis |
| 4–5 | ~27–41% 30-day (higher in older series) | High | Inpatient; ICU consideration; early antibiotics and resuscitation |
| Feature | CURB-65 | PSI |
|---|---|---|
| Variables | 5 bedside/lab items | Age, comorbidities, vitals, labs, mental status (20+ points) |
| Speed | Minutes at bedside | Worksheet or EMR calculator |
| Output | Integer 0–5 | Risk class I–V |
| Guideline use | Widely used in UK/Europe; ED quick screen | Common in US hospital pathways |
| Limitation | Coarse; misses some hypoxemia without tachypnea | More data entry; under-triage debate in young patients |
| Item | CRB-65 | CURB-65 |
|---|---|---|
| Urea / BUN | Omitted (primary care without labs) | Required for full score |
| Max score | 4 | 5 |
| Best setting | Office assessment before labs return | ED/ward with chemistry available |
C (Confusion): 0 — New acute confusion
U (Urea/BUN): +1 — BUN 22 >19 mg/dL
R (Respiratory rate): 0 — RR 28 ≥30/min
B (Blood pressure): 0 — SBP 100 / DBP 68 (low if SBP<90 or DBP≤60)
65 (Age): +1 — Age 72 ≥65 years
Total 2 → Score 2 often prompts short inpatient stay, hospital-supervised outpatient therapy, or enhanced outpatient follow-up depending on stability and comorbidity.
Total 5 / 5 → High risk.
Original cohorts reported approximate 30-day mortality near 0.7%, 9.2%, and 15% for scores 0, 1, and 2, and higher for 3+; modern outcomes vary with vaccination, pathways, and case mix.
Education only. Not for pediatric pneumonia, ICU ventilator management, or antibiotic prescribing without clinician and local antibiogram review. Hypoxemia can override a low score.
For ED, hospital medicine, and pharmacy teaching