Community-acquired pneumonia
Severity assessment in primary care

When a clinical diagnosis of community-acquired pneumonia is made in primary care, determine whether patients are at low, intermediate or high risk of death using the CRB65 score .

CRB65 score for mortality risk assessment in primary care.

CRB65 score is calculated by giving 1 point for each of the following prognostic features:

confusion (abbreviated Mental Test score 8 or less, or new disorientation in person, place or time)

raised respiratory rate (30 breaths per minute or more)

low blood pressure (diastolic 60 mmHg or less, or systolic less than 90 mmHg)

age 65 years or more.

Patients are stratified for risk of death as follows:

0: low risk (less than 1% mortality risk)
1 or 2: intermediate risk (1- 10% mortality risk)
3 or 4: high risk (more than 10% mortality risk).

Use clinical judgement in conjunction with the CRB65 score to inform decisions about whether patients need hospital assessment as follows:

consider home based care for patients with a CRB65 score of 0

consider hospital assessment for all other patients, particularly those with a CRB65 score of 2 or more.

G Mohan.

To follow – Severity assessment in Hospital.