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

Respir Med. 2011 Nov;105(11):1732-8. doi: 10.1016/j.rmed.2011.07.006. Epub 2011 Aug 6.


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.

Publication types

  • Evaluation Study

MeSH terms

  • Aged
  • Choice Behavior*
  • Community-Acquired Infections / diagnosis
  • Decision Making
  • Female
  • Hospitalization / statistics & numerical data
  • Humans
  • Italy / epidemiology
  • Male
  • Patient Discharge / statistics & numerical data*
  • Pneumonia / diagnosis*
  • Pneumonia / epidemiology
  • Pneumonia / physiopathology
  • Practice Guidelines as Topic
  • Predictive Value of Tests
  • Retrospective Studies
  • Risk Factors
  • Sensitivity and Specificity
  • Severity of Illness Index