Low CURB-65 is of limited value in deciding discharge of patients with community-acquired pneumonia.

Link to article at PubMed

Low CURB-65 is of limited value in deciding discharge of patients with community-acquired pneumonia.

Respir Med. 2011 Nov;105(11):1732-8

Authors: Aliberti S, Ramirez J, Cosentini R, Brambilla AM, Zanaboni AM, Rossetti V, Tarsia P, Peyrani P, Piffer F, Blasi F

Abstract
BACKGROUND: The relationship between clinical judgment and indications of the CURB-65 score in deciding the site-of-care for patients with community-acquired pneumonia (CAP) has not been fully investigated. The aim of this study was to evaluate reasons for hospitalization of CAP patients with CURB-65 score of 0 and 1.
METHODS: An observational, retrospective study of consecutive CAP patients was performed at the Fondazione Cà Granda, Milan, Italy, between January 2005 and December 2006. The medical records of hospitalized patients with CAP having a CURB-65 score of 0 and 1 were identified and reviewed to determine whether there existed a clinical basis to justify hospitalization.
RESULTS: Among the 580 patients included in the study, 218 were classified with a CURB-65 score of 0 or 1. Among those, 127 were hospitalized, and reasons that justified hospitalization were found in 104 (83%) patients. Main reasons for hospitalization included the presence of hypoxemia on admission (35%), failure of outpatient therapy (14%) and the presence of cardiovascular events on admission (9.7%). Used as the sole indicator for inappropriate hospitalization, the CURB-65 score had a poor positive predictive value of 52%.
CONCLUSIONS: Although the CURB-65 has been proposed as a tool to guide the site of care decision by international guidelines, this score is not ideal by itself, and should not be regarded as providing decision support information if a score of 0 and 1 is present. In CAP patients with CURB-65 scores of 0 or 1, further evaluations should be performed and completed by clinical judgment.

PMID: 21821405 [PubMed - indexed for MEDLINE]

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