Tags
Emerg. Med. Practice
Published
February 1, 2021
Author(s)
Matthew DeLaney, MD, FACEP, FAAEM;
Charles Khoury, MD, MSHA, FACEP
Decision
Calculate a pneumonia risk score to determine disposition:
Background
“Both the CURB-65 and the PSI scores have reliable sensitivity in identifying high-risk patients, but CURB-65 is more specific (74.6% vs 52.2%). One possible explanation for the lower specificity of the PSI is its inclusion of comorbidities. With PSI, otherwise well-appearing patients with comorbid conditions may have an elevated score without increased mortality. Conversely, when using CURB-65, consider the presence of significant underlying medical conditions when evaluating a patient, as the score does not incorporate these elements.” (1)
Calculate CURB-65
- MD Calc (opens browser window)
Symptoms | Points |
Confusion | 1 |
Urea: BUN >19 mg/dL (>7 mmol/L) | 1 |
Respiratory rate ≥30 breaths/min | 1 |
Systolic BP <90 mm Hg or diastolic BP ≤60 mm Hg | 1 |
Age ≥65 years | 1 |
Score | Risk | Disposition |
0 or 1 | 1.5% mortality | Outpaitent Care |
2 | 9.2% mortality | Inpatient versus observation admission |
>3 | 22% mortality | Inpatient admission; consider ICU admission with score 4 or 5 |
Or
Calculate Pneumonia Severity Index (PSI)
- MD Calc (opens browser window)
Score, Class | Risk | Disposition |
< 70, class II | Low | Outpatient care |
71-90, class III | Low | Outpatient versus observation admission |
91-130, class IV | Moderate | Inpatient admission |
> 130, class IV | High | Inpatient admission |
References:
- DeLaney M, Khoury C. Community-acquired pneumonia in the emergency department. Emerg Med Pract. 2021 Feb;23(2):1-24. Epub 2021 Feb 1. PMID: 33476506.
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Inpatient Treatment
Outpatient Treatment
Full Pneumonia Pathway