Terms used in the guideline

Severity assessment in adults

The NICE guideline on pneumonia in adults recommends that healthcare professionals use clinical judgement along with CRB65 or CURB65 score to assess the severity of community-acquired pneumonia.

Severe community-acquired pneumonia in children and young people

Features of severe community-acquired pneumonia in children and young people include difficulty breathing, oxygen saturation <90%, raised heart rate, grunting, very severe chest indrawing, inability to breastfeed or drink, lethargy and a reduced level of consciousness.

CRB65

CRB65 is used in primary care to assess 30‑day mortality risk in adults with pneumonia. The score is calculated by giving 1 point for each of the following prognostic features: confusion, respiratory rate ≥30/minute, low systolic [<90 mmHg] or diastolic [≤60 mmHg] blood pressure, age ≥65). Risk of death is stratified as follows:

  • 0: low risk (less than 1% mortality risk)

  • 1 or 2: intermediate risk (1% to 10% mortality risk)

  • 3 or 4: high risk (more than 10% mortality risk).

CURB65

CURB65 is used in hospital to assess 30‑day mortality risk in adults with pneumonia. The score is calculated by giving 1 point for each of the following prognostic features: (confusion, urea >7 mmol/l, respiratory rate ≥30/minute, low systolic [<90 mmHg] or diastolic [≤60 mmHg] blood pressure, age ≥65). Risk of death is stratified as follows:

  • 0 or 1: low risk (less than 3% mortality risk)

  • 2: intermediate risk (3% to 15% mortality risk)

  • 3 to 5: high risk (more than 15% mortality risk).

Adults with score of 1 and particularly 2 are at increased risk of death (should be considered for hospital referral) and people with a score of 3 or more are at high risk of death (require urgent hospital admission).

  • Public Health England – Alcohol and drug misuse prevention and treatment collection
  • National Institute for Health and Care Excellence (NICE)