Pneumonia Community Acquired



CURB-65 score
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.



Content by Dr Íomhar O' Sullivan 21/12/2004 Based on BTS Guidelines Management of Community Acquired Pneumonia 2004. Additional material and CUH Respiratory Protocols (Beware LARGE file download) supplied by Dr Mike Henry 12/11/2007. Reviewed by Dr ÍOS 26/06/2009. Last review Dr ÍOS 31/05/21.