CURB-65 turns five ordinary bedside findings into a disposition decision — home, floor or intensive care. Build a patient below, watch each criterion trip, and read every supporting lab against the threshold that triggers a call. Change the age to 84 and the temperature to 37.2 °C to see why new confusion in an older adult is pneumonia until proven otherwise.
Start from a case
The five CURB-65 findings
Point at 65 or older
Normal 7–20; point above 19
Count a full minute; point at 30 or more
Point if under 90
Point if 60 or less
Any new disorientation counts
Supporting labs and vitals
Normal 5,000–10,000
Normal 0.5–2.0
Above about 0.25 favours bacterial
Under 92 signals hypoxemic failure
Normal 80–100; under 60 is failure
Fever often 38.3 or higher
Which pneumonia is this?
Why the class matters
The classification is not bookkeeping — it chooses the antibiotic. Change the tab and watch the empiric therapy change on the right.
0
What the numbers are telling you
Cultures before antibiotics — antibiotics before perfection
Draw two sets of blood cultures and a sputum specimen if you can obtain them promptly, then give the drug. Sepsis guidance is antimicrobials within one hour of recognising sepsis or septic shock, so never hold the dose waiting on a specimen. A slightly less informative culture costs nothing; a delayed antibiotic costs lives.
The nursing that actually changes the outcome
Upright or semi-Fowler’s; in unilateral disease place the good lung down so gravity sends perfusion to the lung that can still oxygenate.
Fluids 2–3 L daily unless heart failure or renal disease restricts it — thick secretions do not clear.
Incentive spirometry ten breaths per hour while awake, held three seconds; splint the chest with a pillow to cough.
Give the analgesia so the patient can cough. Pleuritic pain makes patients splint, and splinting makes atelectasis.
Mobilise early — a patient sitting in a chair for meals has fewer complications than one on bed rest.
Treat a minimum of five days and until afebrile 48–72 hours and clinically stable.
Older adults break the rules
A blunted febrile response means an infected 84-year-old may run 37.2 °C. Diminished cough and gag, reduced chest wall compliance and a lower baseline PaO2 (a value in the low 80s can be normal at 80 years) mean the reserve is already spent. Delirium, a fall or anorexia is pneumonia until proven otherwise — the confusion arrives before the fever, before the cough and before any change in saturation.