Severity assessment
A clinical diagnosis of community acquired pneumonia should be followed by assessment for risk of dying due to pneumonia in the next 30 days using the CRB65 scoring system. This stands for Confusion, Respiration, Blood pressure and 65 years.3
One point is given for:
· - confusion (with an abbreviated Mental Test score 8 or less, or new disorientation in person, place or time).
· - raised respiratory rate of 30 breaths per minute or more
· - low blood pressure of diastolic 60 mmHg or less, or systolic less than 90 mmHg
· - age 65 years or more.
In hospital, scoring is with the CURB65 which adds a score of 1 if the blood Urea nitrogen level is over 7 mmol/litre.
CAP severity levels and mortality risk are summarised in table 1.
Table1: CRB65 and CURB65 score indicators
|
|
CRB65 |
CURB 65 |
||
|
Severity |
score |
mortality risk |
score |
mortality risk |
|
Low risk |
0 |
< 1% |
0 or 1 |
<3% |
|
Intermediate risk |
1 or 2 |
1% – 10% |
2 |
3% - 15% |
|
High risk |
3 or 4 |
>10% |
3 to 5 |
>15% |
(Adapted from NICE CG 1913 section 1.2)
For CAP, taking into account other factors such as pregnancy or other comorbidities, a score of 0 would suggest home care is suitable for the patient. If the score is 1, supported home-based care using a virtual ward community intervention team may be appropriate. A score of 2 or more would usually require a hospital assessment.3