A 76-year-old man with community-acquired pneumonia has confusion, respiratory rate 30/min, blood pressure 88/54 mmHg, urea 48 mg/dL, and is breathing spontaneously at 8 breaths via mask with SpO2 89%. His CURB-65 score is calculated. Which management decision follows from this score?
- A Treat as outpatient with oral amoxicillin
- B Admit to ward for IV antibiotics
- C Assess for intensive care with consideration of ventilatory support ✓
- D Discharge after nebulised bronchodilators
Correct answer: C. Assess for intensive care with consideration of ventilatory support
Explanation
CURB-65 assigns one point each for Confusion, Urea above 7 mmol/L, Respiratory rate 30 or more, Blood pressure systolic under 90 or diastolic 60 or less, and age 65 or more. This patient scores 5, indicating severe pneumonia with high mortality, mandating critical care assessment and consideration of ventilatory or inotropic support. Outpatient treatment applies to scores 0 to 1 and general ward admission to scores 2 to 3.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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