Daily Bolus of LR: CURB 65 and PORT scores

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November 13, 2012 by dailybolusoflr

Courtesy of Dr. Ryan Circh
CURB 65 and PORT scores
The PORT/PSI score and CURB-65 are two clinical scoring systems for community-acquired pneumonia that were established to stratify patients into classes of severity. Since their creation, they have been well validated to identify low-risk patients who are amenable to outpatient treatment. Both have struggled to accurately and safely identify patients requiring higher levels of care, particularly patients requiring the ICU (more on ICU scoring systems in a Daily Bolus coming soon).
Neither of these scoring systems have been proven to be better than the other. It is important to use these scoring systems only as an aid and not a decision tool.

CURB-65 is much easier than the PORT score to calculate in the ED. Each variable counts for one point

  • Confusion
  • BUN >19
  • Respiratory Rate >30
  • Blood pressure systolic <90 or diastolic <60
  • Age >65

CURB-65 recommends
Low risk score 0-1: outpatient treatment
Moderate risk score 2: inpatient versus outpatient with good follow up
Severe risk score >3: inpatient with ICU consideration in severe

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For the PORT/PSI score, use a medical calculator as there are many variables and varying point values. In short, variables include:
  • Age
  • Female
  • Nursing home resident
  • Neoplastic disease history
  • Liver disease
  • CHF
  • CVA
  • Renal disease
  • Altered mental status
  • Respiratory rate >29
  • Systolic BP <90
  • Temperature 40
  • Pulse >124
  • pH <7.35
  • BUN >29
  • Sodium <130
  • Glucose >249
  • Hematocrit <30%
  • Partial pressure of oxygen <60
  • Pleural effusion on x-ray

PORT score recommends
Class I/II score <70: outpatient treatment
Class III score 71-90: observe, short admission, or outpatient with close follow up
Class IV score 91-130: inpatient treatment
Class V score >130: ICU

References
1. A Prediction Rule to Identify Low-Risk Patients with Community-Acquired Pneumonia.
Fine JF, Auble TE, et al. N Engl J Med 1997; 336:243-250

2. BTS guidelines for the management of community acquired pneumonia in adults: update
2009.
Lim WS, Baudouin SV, George RC, et al. Thorax 2009. 64(Suppl 3): iii1-iii55.

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