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

Stefano Aliberti, Julio Ramirez, Roberto Cosentini, Anna Maria Brambilla, Anna Maria Zanaboni, Valeria Rossetti, Paolo Tarsia, Paula Peyrani, Federico Piffer, Francesco Blasi

Research output: Contribution to journalArticlepeer-review

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 C 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.

Original languageEnglish
Pages (from-to)1732-1738
Number of pages7
JournalRespiratory Medicine
Volume105
Issue number11
DOIs
Publication statusPublished - Nov 2011

Keywords

  • Cardiovascular events
  • Community-acquired pneumonia
  • CURB-65 score
  • Hospitalization
  • Hypoxemia
  • Site-of-care

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

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