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| Tis the Season for Pneumonia: Aids for Risk Stratification in Adults with Community Acquired Pneumonia |
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by Christy Wilson PA-C, MPAS - December 6, 2011
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Winter has arrived, which means the days are filled with busy clinics and emergency rooms packed with coughing patients. This season, be prepared to identify which adult patients with Community Acquired Pneumonia (CAP) need to be admitted to the hospital by using CURB-65 or PSI (Pneumonia Severity Index). Although PSI is highly recommended in determining the appropriate location for treatment, it is often times too complex for clinicians to use during a busy day in the office or emergency department. However, CURB-65 is a simple way to determine risk stratification of adult patients with CAP by reviewing 5 measurable factors.
CURB-65 stands for:
Confusion (new disorientation to person, place or time)
Urea (BUN > 20 mg/dL) = 1 point
Respiratory Rate > 30 breaths/minute = 1 point
Blood Pressure (systolic < 90 mmHg or diastolic < 60 mmHg) = 1 point
Age >65 years = 1 point
To calculate CURB-65 score, each factor is worth one point if positive. A patient with a score of 2 points should be admitted to the hospital for closer monitoring and care. A patient with a score of 3 points should be carefully assessed for ICU admission. If a patient has a score of zero or one, treating as an outpatient is recommended. If a clinician does not have laboratory data available, CRB-65 recommends a patient with a score of one or more should be admitted to the hospital.
Both the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS) recommend using either CURB-65 or Pneumonia Severity Index (PSI) as a tool to aid in the decision of initial site of treatment in adult patients with CAP.
This season make the correct choice in determining site of treatment for adult patients with Community Acquired Pneumonia by using CURB-65.
Christy Wilson is a graduate of Saint Francis University with a Masters in Physician Assistant Sciences, and for nearly a decade has treated patients at Georgia Lung Associates, the largest pulmonary/critical care practice in the Southeast. She serves in the leadership for her state society and enjoys guest speaking and mentoring PA students at some of Georgia's PA programs. She is a member of the American College of Chest Physicians as well as AAPA and GAPA, and lectures across the country at a variety of training programs.
Christy will be speaking at the upcoming DMGCME conferences in Las Vegas and Walt Disney World.
The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.
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