CURB-65 and PSI: pneumonia severity scoring and risk stratification

Three questions, three kinds of score

A score that predicts death is not a score that picks the ICU bed. The 2019 ATS/IDSA guideline separates three decisions. ^[3][4]

1. Who is likely to die? The PSI and CURB-65 were developed in immunocompetent patients with pneumonia, using demographic and clinical variables from the time of diagnosis to predict 30-day mortality.
2. Who needs hospital admission? Use a validated clinical prediction rule for prognosis, preferentially the PSI over CURB-65, in addition to clinical judgement.
3. Who needs a higher level of inpatient care? The PSI and CURB-65 were not designed to help select the level of care. Admit directly to ICU with hypotension requiring vasopressors or respiratory failure requiring mechanical ventilation; otherwise use the 2007 IDSA/ATS minor criteria together with clinical judgement. SMART-COP was derived to predict the need for IRVS. ^[3][4]

Why mis-triage matters. Patients transferred to an ICU after admission to a hospital ward have higher mortality than those admitted directly to the ICU from an emergency department, and unrecognised severe pneumonia may contribute. ^[3]

References10ShowHide

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