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  1. Gavin Barlow
  1. Castle Hill Hospital, Cottingham, East Yorkshire HU16 5JQ, UK
    ; gavin.barlow{at}tesco.net

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We agree with Myint and colleagues that CURB-65 will not perform equally in all cohorts of patients. We have previously shown, however, that knowledge among junior and middle grade medical staff about how to perform and apply severity assessment criteria in patients with community acquired pneumonia (CAP) is poor.1 2 This may have improved since the inclusion of CURB-65 in the British Thoracic Society (BTS) guidelines in 2004, but it is our anecdotal experience that severity assessment remains suboptimal. When implementing guidelines, there is a widely accepted paradigm that increasing complexity results in decreased adherence. While the modification proposed by Myint and colleagues may be a statistical improvement, the key question is: Will the improved performance characteristics outweigh the inevitable increased confusion and decreased use as a result of the increased complexity and yet another change to the recommended prognostic criteria for CAP?

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