Quality statement 4: Mortality risk assessment in hospital using CURB65 score

Quality statement

Adults have a mortality risk assessment using the CURB65 score when they are diagnosed with community‑acquired pneumonia in hospital.

Rationale

Assessing mortality risk using the CURB65 score in hospital informs clinical judgement and supports decision‑making about how the infection is treated, whether the person should receive home‑ or hospital‑based care, the choice of microbiological tests and the choice of antibiotic. This will ensure that treatment is based on the severity of the infection and will improve treatment outcomes.

Quality measures

Structure

Evidence of local arrangements to ensure that adults have a mortality risk assessment using the CURB65 score when they are diagnosed with community‑acquired pneumonia in hospital.

Data source: Local data collection.

Process

Proportion of diagnoses of community‑acquired pneumonia in adults in hospital at which the adult has a mortality risk assessment using the CURB65 score.

Numerator – the number in the denominator at which the adult has a mortality risk assessment using the CURB65 score.

Denominator – the number of diagnoses of community‑acquired pneumonia in adults in hospital.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (secondary care and ambulatory care services) ensure that adults have a mortality risk assessment using the CURB65 score when they are diagnosed with community‑acquired pneumonia in hospital.

Healthcare professionals (such as hospital doctors and nurse practitioners) carry out a mortality risk assessment using the CURB65 score when adults are diagnosed with community‑acquired pneumonia in hospital.

Commissioners (clinical commissioning groups) commission services in which adults have a mortality risk assessment using the CURB65 score when they are diagnosed with community‑acquired pneumonia in hospital.

What the quality statement means for patients, service users and carers

Adults diagnosed with community‑acquired pneumonia in hospital have an assessment to find out how serious the pneumonia is. This includes a CURB65 score, which uses the person's age, symptoms, blood pressure and a blood test to help decide how serious the risks are for that person, whether they need to stay in hospital and what treatment they should have.

Source guidance

Pneumonia in adults: diagnosis and management (2014) NICE guideline CG191, recommendations 1.2.3 and 1.2.4

Definitions of terms used in this quality statement

Community‑acquired pneumonia

Pneumonia that is acquired outside hospital. Pneumonia that develops in a person living in a nursing or residential home is included in this definition. Pneumonia that develops in people who are immunocompromised, and terminal pneumonia associated with another disease are not included.

[Pneumonia in adults (2014) NICE guideline CG191 and expert opinion]

Mortality risk assessment in hospital

When a diagnosis of community‑acquired pneumonia is made at presentation to hospital, the healthcare professional should assess whether the person is at low, intermediate or high risk of death by calculating the CURB65 score (box 2).

Box 2 CURB65 score for mortality risk assessment in hospital 1

CURB65 score is calculated by giving 1 point for each of the following prognostic features:

  • confusion (abbreviated Mental Test score 8 or less, or new disorientation in person, place or time)2

  • raised blood urea nitrogen (over 7 mmol/litre)

  • raised respiratory rate (30 breaths per minute or more)

  • low blood pressure (diastolic 60 mmHg or less, or systolic less than 90 mmHg)

  • age 65 years or more.

Patients are stratified for risk of death as follows:

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

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

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

1 Lim WS, van der Eerden MM, Laing R et al. (2003) Defining community‑acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 58: 377–82.

2 For guidance on delirium, see the NICE guideline on delirium.

[Pneumonia in adults (2014) NICE guideline CG191, recommendation 1.2.3]

Equality and diversity considerations

It is important to be aware of dementia when assessing confusion and to adapt the assessment approach to meet individual needs.

Healthcare professionals should be aware of the needs of people at the end of life and agree the approach for managing pneumonia in the context of their overall care plan.