| C | Confusion |
|---|---|
| U | Urea >7 |
| R | Resp. rate >30 |
| BP | SBP <90 mmHg or DBP <60 mmHg |
| Age | >65 |
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.
Algorithm
Treatment and management
Please follow the current HSE-S guidelines on NCHD.ie.
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 |
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.