Background
- Patients who have a CURB-65 score of 3 or more are at high risk of death and should be managed as having severe pneumonia according to the BTS recommendations and require urgent hospital admission
- Patients who have a CURB-65 score of 2 are at increased risk of death. They should be considered for short stay inpatient treatment or hospital supervised outpatient treatment. This decision is a matter of clinical judgement
- Patients who have a CURB-65 score of 0 or 1 are at low risk of death. They can be treated as having non-severe pneumonia and may be suitable for home treatment
| C | Confusion |
|---|---|
| U | Urea >7 |
| R | Resp. rate >30 |
| BP | SBP <90 mmHg or DBP <60 mmHg |
| Age | >65 |
Algorithm
Clinical features severe pneumonia
| Clinical | Lab | Investigations needed |
|---|---|---|
| Resp. rate > 30/min Diastolic BP < 60mmHg Underlying disease Age > 60 years Multilobar involvement |
Urea > 7mmol/L pO2 < 9kPa WBC < 4.0 WBC > 20.0 |
Blood cultures sputum culture Clotted blood for viral / atypical serology Urine for legionella antigen |
Treatment and management
Please follow the current HSE-S guidelines on NCHD.ie.
Red flags and pitfalls
Patients suitable for discharge should not have more than one of the following characteristics present (unless they represent the usual baseline status for that patient).
- Temperature > 37.8° C
- Heart Rate >100/min
- Respiratory rate >24/min
- Systolic BP <90mmHg
- O2 sats. <90%
- Inability to maintain oral intake and abnormal mental status
A follow up appointment should be arranged (GP to complete) for 6-8 weeks with a CXR to ensure resolution of the consolidation and no underlying malignant process particularly in smokers.
Switching IV to PO
Please see NCHD.ie.