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Appendix 9: CURB-65 and the Pandemic Medical Early Warning Score
By estimating the likelihood of death from community-acquired pneumonia, the CURB-65 scoring system can assist clinical decision-making when considering admission from this condition. The Department of Health, the British Thoracic Society, the British Infection Society and the Health Protection Agency currently recommend CURB-65 for use when assessing patients with influenza-like illness during a pandemic. 67
One point is allocated for each of:
- Confusion mental test score <8 or new disorientation in person, place and time
- Urea >7mmol/l
- Respiratory rate =30/min
- Blood pressure, systolic (<90mmHg) or diastolic (=60mmHg)
- Age = 65 years.
The score for each parameter is added together, and the higher the score, the greater the likelihood of death, therefore the greater the need for intervention. Under normal situations, people with a score of 0 or 1 would be managed at home and those with higher scores would be considered for admission to hospital. The Pandemic Medical Early Warning Score ( PMEWS) 68 has been developed to identify those patients with community-acquired pneumonia who have the greatest mortality risk and thus the greatest need for hospital care. Some of the parameters are common to CURB-65, but PMEWS includes additional factors that are more social in nature.
The drawback of both these systems is that they are limited to community-acquired pneumonia, and in the pandemic situation those with the greatest risk of dying may not be the patients prioritised for treatment.
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