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CURB-65 severity score for community-acquired pneumonia.
Clinical decision-support tool for qualified healthcare professionals. Results are not a diagnosis and should not replace professional clinical judgment.
The CURB-65 score is a validated, five-point severity index for adults with community-acquired pneumonia (CAP). It estimates 30-day mortality risk and helps guide site-of-care decisions: outpatient treatment, hospital admission, or intensive care. Each of the five criteria scores one point: Confusion (new-onset, defined as recent disorientation to person, place, or time), Urea > 7 mmol/L (approximately > 20 mg/dL), Respiratory rate ≥ 30 breaths/min, Blood pressure (systolic < 90 mmHg or diastolic ≤ 60 mmHg), and Age ≥ 65 years. The total score ranges from 0 to 5. A score of 0–1 indicates low severity with mortality risk < 2%, and outpatient management is usually appropriate when oxygenation is adequate and follow-up is reliable. A score of 2 indicates moderate severity with approximately 9% 30-day mortality; hospital admission should be strongly considered. A score of ≥ 3 indicates severe disease with mortality risk of 15–40% and warrants urgent hospital assessment and evaluation for ICU-level care. Important limitations: CURB-65 does not assess oxygenation, immunocompromise, or multiorgan dysfunction. Hypoxemia (PaO₂ < 60 mmHg or SpO₂ < 92%) or significant clinical instability should prompt a higher level of care regardless of the CURB-65 score. The score should always be used alongside clinical judgment, assessment of comorbidities, functional status, and social circumstances. It is not validated for hospital-acquired pneumonia, ventilator-associated pneumonia, or pediatric patients.
Specialty
Emergency MedicineCategory
EmergencyDifficulty
Basic
Estimated Time
30 seconds
Version
1.0
Last Updated
2026-08-06
Formula
Keywords
Normal Range
0–5
Stratifies severity and 30-day mortality risk in adults with community-acquired pneumonia (CAP) to help guide site-of-care decisions.
The CURB-65 score sums five one-point criteria: new-onset Confusion, Urea > 7 mmol/L, Respiratory rate >= 30/min, Systolic blood pressure < 90 mmHg (or diastolic <= 60 mmHg), and Age >= 65 years. The total ranges from 0 to 5.
Age in years; one point is added when age is 65 or older.
New disorientation to person, place, or time; Yes adds one point.
Blood urea in mmol/L; a value greater than 7 mmol/L adds one point.
Respiratory rate per minute; 30 or more breaths per minute adds one point.
Systolic blood pressure in mmHg; below 90 mmHg adds one point.
CURB-65 is scored 0–5 with one point each for new-onset confusion, urea > 7 mmol/L, respiratory rate ≥ 30/min, systolic blood pressure < 90 mmHg, and age ≥ 65. Scores of 0–1 are typically managed as outpatients; a score of 2 suggests hospital admission; a score ≥ 3 indicates severe pneumonia and consideration of ICU-level care.
CURB-65 is a validated, widely used tool that predicts 30-day mortality in community-acquired pneumonia and helps avoid both unnecessary admission of low-risk patients and unsafe discharge of high-risk patients.
A 70-year-old man with community-acquired pneumonia has no new-onset confusion, urea 8.5 mmol/L, respiratory rate 24/min, and systolic blood pressure 105 mmHg.
Inputs:
Expected Result: CURB-65 = 2 (age ≥ 65 and urea > 7 mmol/L). Moderate severity — strongly consider hospital admission.
Each criterion scores 1 point: Confusion, Urea >7 mmol/L, Respiratory rate >=30, Blood pressure <90 systolic or <60 diastolic, age >=65. 0-1: low risk, consider outpatient. 2: consider admission. 3 or more: severe, consider ICU.
CURB-65 is faster to calculate at the bedside (no lab values required beyond urea). PSI/PORT is more detailed but requires more data. Both are validated for community-acquired pneumonia in adults.
No. CURB-65 does not include hypoxia or oxygen requirements. Supplemental clinical assessment of oxygenation is essential alongside the score.
Disclaimer: This calculator is intended for educational and clinical decision support purposes only. Severity scores inform but do not replace clinical judgment, especially in patients with hypoxia, sepsis, or significant comorbidity.