You pick up a 65 year old man with no known past medical history and a chief complaint of cough and fever for three days.
On physical exam you find a slightly confused man with an unhealthy obsession with Larry David, who is febrile and has crackles in his left lung base. Otherwise, the exam is within normal limits.
His labs reveal a CBC with a hemoglobin of 13.2 g/dL, and a Comprehensive panel with Na: 136mEq/dl, K: 4.8 mEq/dl, a BUN of 20 mg/dl and Creatinine: 0.7mg/dl.
His Chest X-ray reveals an opacification highly suggestive of a left lower lobe pneumonia.
What is this poor man's 30 day risk of dying of pneumonia (low, moderate or high)?
High according to the CURB-65 score (14%, to be precise). This patient gets 1 point for age, 1 for confusion and 1 point for BUN>19 (0-1 mild: consider outpatient. 2 Moderate: consider short inpatient course or supervised home treatment, 3-5 severe: consider inpatient and ICU treatment).
A little more...
The CURB-65 score was created using the data of a large multinational retrospective study that was validated several times. Its utility, like many other clinical scores, does not supplant clinical decision making. However, to the inexperienced clinician this score can help when there is a doubt about equivocal cases, when considering outpatient versus inpatient treatment, or when justifying ICU admissions.
References:
Uptodate: Community-acquired pneumonia in adults: Risk stratification and the decision to admit
MDCALC
Written by Dr. Itamar
Special thanks to Dr. Willis
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Itamar
Resident in the combined Emergency and Internal Medicine program at Kings County Hospital and SUNY Downstate Medical Centers.
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1 Comment
ablumenberg · July 7, 2015 at 10:58 pm
Pretty pretty pretty pretty good post