CURB-65: Difference between revisions

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'''CURB-65''' is a validated score for predicting mortality in community-acquired [[pneumonia]]<ref name="pmid12728155">{{cite journal |author=Lim WS, van der Eerden MM, Laing R, ''et al'' |title=Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study |journal=Thorax |volume=58 |issue=5 |pages=377-82 |year=2003 |pmid=12728155 |doi=}}</ref> and infection of any site<ref name="pmid17576773">{{cite journal |author=Howell MD, Donnino MW, Talmor D, Clardy P, Ngo L, Shapiro NI |title=Performance of severity of illness scoring systems in emergency department patients with infection |journal=Academic emergency medicine : official journal of the Society for Academic Emergency Medicine |volume=14 |issue=8 |pages=709-14 |year=2007 |pmid=17576773 |doi=10.1197/j.aem.2007.02.036}}</ref>. The CURB-65 is based on the earlier CURB score<ref name="pmid11254821">{{cite journal |author=Lim WS, Macfarlane JT, Boswell TC, ''et al'' |title=Study of community acquired pneumonia aetiology (SCAPA) in adults admitted to hospital: implications for management guidelines |journal=Thorax |volume=56 |issue=4 |pages=296-301 |year=2001 |pmid=11254821 |doi=}}</ref> and is recommended by the [[British Thoracic Society]] for the assessment of severity of pneumonia.<ref name="pmid11713364">{{cite journal |author= |title=BTS Guidelines for the Management of Community Acquired Pneumonia in Adults |journal=Thorax |volume=56 Suppl 4 |issue= |pages=IV1-64 |year=2001 |pmid=11713364 |doi=}}</ref>
'''CURB-65''' is a validated score for predicting mortality in community-acquired [[pneumonia]]<ref name="pmid20883616">{{cite journal| author=McNally M, Curtain J, O'Brien KK, Dimitrov BD, Fahey T| title=Validity of British Thoracic Society guidance (the CRB-65 rule) for predicting the severity of pneumonia in general practice: systematic review and meta-analysis. | journal=Br J Gen Pract | year= 2010 | volume= 60 | issue= 579 | pages= e423-33 | pmid=20883616 | doi=10.3399/bjgp10X532422 | pmc=PMC2944951 | url= }} </ref><ref name="pmid12728155">{{cite journal |author=Lim WS, van der Eerden MM, Laing R, ''et al'' |title=Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study |journal=Thorax |volume=58 |issue=5 |pages=377-82 |year=2003 |pmid=12728155 |doi=}}</ref> and infection of any site<ref name="pmid17576773">{{cite journal |author=Howell MD, Donnino MW, Talmor D, Clardy P, Ngo L, Shapiro NI |title=Performance of severity of illness scoring systems in emergency department patients with infection |journal=Academic emergency medicine : official journal of the Society for Academic Emergency Medicine |volume=14 |issue=8 |pages=709-14 |year=2007 |pmid=17576773 |doi=10.1197/j.aem.2007.02.036}}</ref>. The CURB-65 is based on the earlier CURB score<ref name="pmid11254821">{{cite journal |author=Lim WS, Macfarlane JT, Boswell TC, ''et al'' |title=Study of community acquired pneumonia aetiology (SCAPA) in adults admitted to hospital: implications for management guidelines |journal=Thorax |volume=56 |issue=4 |pages=296-301 |year=2001 |pmid=11254821 |doi=}}</ref> and is recommended by the [[British Thoracic Society]] for the assessment of severity of pneumonia.<ref name="pmid11713364">{{cite journal |author= |title=BTS Guidelines for the Management of Community Acquired Pneumonia in Adults |journal=Thorax |volume=56 Suppl 4 |issue= |pages=IV1-64 |year=2001 |pmid=11713364 |doi=}}</ref>


The score is an [[Wiktionary:acronym|acronym]] for each of the risk factors measured.  Each risk factor scores one point, for a maximum score of 5:
The score is an [[Wiktionary:acronym|acronym]] for each of the risk factors measured.  Each risk factor scores one point, for a maximum score of 5:
* confusion (defined as an [[abbreviated mental test score|AMT]] of 8 or less)
* confusion (defined as an [[abbreviated mental test score|AMT]] of 8 or less)
* urea greater than 7 mmol/l
* urea greater than 7 mmol/l (19.6 mg/dl)
* respiratory rate of 30 breaths per minute or greater
* respiratory rate of 30 breaths per minute or greater
* blood pressure less than 90 systolic or diastolic blood pressure 60 or less
* blood pressure less than 90 systolic or diastolic [[blood pressure]] 60 or less
* age 65 or older
* age 65 or older
Removing the effect of age may improve accuracy.<ref name="pmid20965934">{{cite journal| author=Chen JH, Chang SS, Liu JJ, Chan RC, Wu JY, Wang WC et al.| title=Comparison of clinical characteristics and performance of pneumonia severity score and CURB-65 among younger adults, elderly and very old subjects. | journal=Thorax | year= 2010 | volume= 65 | issue= 11 | pages= 971-7 | pmid=20965934 | doi=10.1136/thx.2009.129627 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20965934  }} </ref> A variation is the CURB-age.<ref name="pmid19691619">{{cite journal| author=Myint PK, Sankaran P, Musonda P, Subramanian DN, Ruffell H, Smith AC et al.| title=Performance of CURB-65 and CURB-age in community-acquired pneumonia. | journal=Int J Clin Pract | year= 2009 | volume= 63 | issue= 9 | pages= 1345-50 | pmid=19691619 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19691619 | doi=10.1111/j.1742-1241.2009.02147.x }}</ref>


==Predicting death from pneumonia==
==Predicting death from pneumonia==
Line 18: Line 20:
* 5&mdash;57.0%
* 5&mdash;57.0%


The CURB-65 has been compared to the [[pneumonia severity index]] in predicting mortality from pneumonia.<ref name="pmid15808136">{{cite journal |author=Aujesky D, Auble TE, Yealy DM, ''et al'' |title=Prospective comparison of three validated prediction rules for prognosis in community-acquired pneumonia |journal=Am. J. Med. |volume=118 |issue=4 |pages=384-92 |year=2005 |pmid=15808136 |doi=10.1016/j.amjmed.2005.01.006}}</ref>
The CURB-65 has been compared to the [[pneumonia severity index]] in predicting mortality from pneumonia and may<ref name="pmid21951687">{{cite journal| author=Ochoa-Gondar O, Vila-Corcoles A, Rodriguez-Blanco T, Ramos F, de Diego C, Salsench E et al.| title=Comparison of three predictive rules for assessing severity in elderly patients with CAP. | journal=Int J Clin Pract | year= 2011 | volume= 65 | issue= 11 | pages= 1165-72 | pmid=21951687 | doi=10.1111/j.1742-1241.2011.02742.x | pmc= | url= }} </ref> or may not<ref name="pmid15808136">{{cite journal |author=Aujesky D, Auble TE, Yealy DM, ''et al'' |title=Prospective comparison of three validated prediction rules for prognosis in community-acquired pneumonia |journal=Am. J. Med. |volume=118 |issue=4 |pages=384-92 |year=2005 |pmid=15808136 |doi=10.1016/j.amjmed.2005.01.006}}</ref> be similar in accuracy.


==Predicting death from any infection==
==Predicting death from any infection==

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CURB-65 is a validated score for predicting mortality in community-acquired pneumonia[1][2] and infection of any site[3]. The CURB-65 is based on the earlier CURB score[4] and is recommended by the British Thoracic Society for the assessment of severity of pneumonia.[5]

The score is an acronym for each of the risk factors measured. Each risk factor scores one point, for a maximum score of 5:

  • confusion (defined as an AMT of 8 or less)
  • urea greater than 7 mmol/l (19.6 mg/dl)
  • respiratory rate of 30 breaths per minute or greater
  • blood pressure less than 90 systolic or diastolic blood pressure 60 or less
  • age 65 or older

Removing the effect of age may improve accuracy.[6] A variation is the CURB-age.[7]

Predicting death from pneumonia

The risk of death increases as the score increases:

  • 0—0.7%
  • 1—3.2%
  • 2—13.0%
  • 3—17.0%
  • 4—41.5%
  • 5—57.0%

The CURB-65 has been compared to the pneumonia severity index in predicting mortality from pneumonia and may[8] or may not[9] be similar in accuracy.

Predicting death from any infection

A cohort study of patients with any type of infection (half of the patients had pneumonia), the risk of death increases as the score increases[3]:

  • 0 to 1 <5% mortality
  • 2 to 3 < 10% mortality
  • 4 to 5 15-30% mortality

References

  1. ↑ McNally M, Curtain J, O'Brien KK, Dimitrov BD, Fahey T (2010). "Validity of British Thoracic Society guidance (the CRB-65 rule) for predicting the severity of pneumonia in general practice: systematic review and meta-analysis.". Br J Gen Pract 60 (579): e423-33. DOI:10.3399/bjgp10X532422. PMID 20883616. PMC PMC2944951. Research Blogging.
  2. ↑ Lim WS, van der Eerden MM, Laing R, et al (2003). "Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study". Thorax 58 (5): 377-82. PMID 12728155. [e]
  3. ↑ 3.0 3.1 Howell MD, Donnino MW, Talmor D, Clardy P, Ngo L, Shapiro NI (2007). "Performance of severity of illness scoring systems in emergency department patients with infection". Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 14 (8): 709-14. DOI:10.1197/j.aem.2007.02.036. PMID 17576773. Research Blogging.
  4. ↑ Lim WS, Macfarlane JT, Boswell TC, et al (2001). "Study of community acquired pneumonia aetiology (SCAPA) in adults admitted to hospital: implications for management guidelines". Thorax 56 (4): 296-301. PMID 11254821. [e]
  5. ↑ (2001) "BTS Guidelines for the Management of Community Acquired Pneumonia in Adults". Thorax 56 Suppl 4: IV1-64. PMID 11713364. [e]
  6. ↑ Chen JH, Chang SS, Liu JJ, Chan RC, Wu JY, Wang WC et al. (2010). "Comparison of clinical characteristics and performance of pneumonia severity score and CURB-65 among younger adults, elderly and very old subjects.". Thorax 65 (11): 971-7. DOI:10.1136/thx.2009.129627. PMID 20965934. Research Blogging.
  7. ↑ Myint PK, Sankaran P, Musonda P, Subramanian DN, Ruffell H, Smith AC et al. (2009). "Performance of CURB-65 and CURB-age in community-acquired pneumonia.". Int J Clin Pract 63 (9): 1345-50. DOI:10.1111/j.1742-1241.2009.02147.x. PMID 19691619. Research Blogging.
  8. ↑ Ochoa-Gondar O, Vila-Corcoles A, Rodriguez-Blanco T, Ramos F, de Diego C, Salsench E et al. (2011). "Comparison of three predictive rules for assessing severity in elderly patients with CAP.". Int J Clin Pract 65 (11): 1165-72. DOI:10.1111/j.1742-1241.2011.02742.x. PMID 21951687. Research Blogging.
  9. ↑ Aujesky D, Auble TE, Yealy DM, et al (2005). "Prospective comparison of three validated prediction rules for prognosis in community-acquired pneumonia". Am. J. Med. 118 (4): 384-92. DOI:10.1016/j.amjmed.2005.01.006. PMID 15808136. Research Blogging.

External links

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