Introduction and Objectives Community Acquired Pneumonia (CAP) accounts for a significant proportion of hospital admissions and is a common cause of mortality and morbidity in UK. CURB-65 is recommended by BTS and widely used to stratify patients according to severity and guide initial treatment (1). As oxygen is not part of the CURB-65 assessment, we incorporated Oxygen saturations (SATS) to CURB-65 to create CURBO2–65 score. We then compared CURBO2–65 with CURB65 to assess if CURBO2–65 would be a superior indicator in identifying patients with severe pneumonia.
Methods We retrospectively reviewed electronic medical records of patients who were diagnosed with CAP between December 2012 and January 2013. CURB-65 was documented for all the cases whilst CURBO2–65 scores were retrospectively calculated. A score of 1 was allocated if SATS were <88% for COPD patients or <94% for non-COPD patients. A score of 1 was added if they were on supplemental Oxygen to maintain their SATS.
Results (see Table 1)
Total of 269 admissions with CAP were analysed. 12 of these 269 patients were admitted to critical care. 2/12 (ITU) patients had a CURBO2–65 score of ≤ 2 whilst 7/12 had a CURB-65 score ≤2. CURBO2–65 also had a better correlation with MEWS than CURB-65 on admission (p < 0.05).
Only 10% of cases with a CURBO2–65 score of 0–1 (5/50) were readmitted within 28 days compared to 15% of cases with a CURB-65 score 0–1 (13/87).
There was a statistically significant correlation between length of stay and CURB-65 (p = 0.0085) and CURBO2–65 (p = 0.0014).
Conclusions CURBO2–65 is superior to CURB-65 in identifying sicker cohort of patients, predicting readmission rates and length of stay. Adding Oxygen to CURB-65 is simple and can be undertaken even in primary care setting (CRBO2–65 instead of CRB-65).
Lim WS et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 2003;58:377–382.