A 65-year-old male with community-acquired pneumonia has a respiratory rate of 32/min, blood pressure 85/55 mmHg, confusion, and blood urea nitrogen of 28 mg/dL. What is his CURB-65 score and recommended management setting?

Answer and explanation

Correct answer: C. Score 5; urgent intensive care unit (ICU) admission

  1. Step 1: CURB-65 criteria (1 point each): Confusion (+1), Urea > 19 mg/dL or BUN > 20 mg/dL (+1), Respiratory rate >= 30/min (+1), Blood pressure < 90 systolic or <= 60 diastolic (+1), Age >= 65 (+1).
  2. Step 2: The patient has Confusion (+1), elevated BUN (+1), RR 32 (+1), BP 85/55 (+1), and Age 65 (+1), totaling score 5.
  3. Step 3: A CURB-65 score >= 3 indicates severe pneumonia requiring hospital admission with consideration for the intensive care unit (ICU).
Answer
Score 5; urgent intensive care unit (ICU) admission.
Why not the others: 'Score 1; outpatient' under-evaluates high-risk hemodynamics and tachypnea; 'Score 2; short stay' is for moderate pneumonia without hypotension; 'Score 3; general medical ward' is acceptable for moderate-severe, but score 4 or 5 mandates ICU evaluation.

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