A 72-year-old man with community-acquired pneumonia has confusion, respiratory rate 32 per minute, blood pressure 96/54 mmHg, blood urea 52 mg/dL, and age above 65. Using CURB-65, what is his score and the recommended site of care?
- A Score 4, consider ICU admission ✓
- B Score 5, admit to ICU
- C Score 3, admit to ward
- D Score 2, treat as outpatient
Correct answer: A. Score 4, consider ICU admission
Explanation
He scores 1 each for Confusion, Urea above 7 mmol/L (about 42 mg/dL), Respiratory rate above 30, and Blood pressure systolic below 90 mmHg, giving 4; age contributes no point beyond the scoring name. B score of 4 carries high mortality and warrants consideration of ICU admission. Score 3 suggests ward admission, score 0 to 1 outpatient care. The urea cutoff of 7 mmol/L is the value that most students misremember, confusing it with creatinine criteria.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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