CURB-65 Score Calculator
Severity assessment for community-acquired pneumonia (CAP). Guides outpatient vs ward vs ICU disposition per BTS, IDSA/ATS, and Indian Chest Society (ICS) guidelines.
CURB-65 Score
0/5
30-day mortality: 0.7%
Disposition
Low risk — Outpatient treatment
Empiric Antibiotic (ICS India 2012)
Oral antibiotics at home. Per ICS India: Amoxicillin 1g TDS × 5–7d (₹40–₹80). Macrolide (azithromycin 500mg OD × 3d, ₹50) if atypical suspected or penicillin allergy. Re-review at 48–72 hrs.
Stop scribbling CURB-65 on prescription pads
EasyClinic pulls confusion, urea, RR, BP, and age straight from the vitals chart, calculates CURB-65 automatically, and writes the correct ICS-India antibiotic onto your e-prescription — with the chemist's MRP shown to the patient.
Also Known As
What is the CURB-65 score?
The CURB-65 score is a five-point severity assessment for adults presenting with community-acquired pneumonia (CAP). Developed by Lim et al. (Thorax, 2003) from the British Thoracic Society's CAP study, it estimates 30-day mortality and helps decide whether a patient should be treated as an outpatient, on a general ward, or in the ICU.
CURB-65 is simpler than the PSI/PORT score (only 5 variables vs 20), making it ideal for the OPD, ED, or first-contact GP setting. A bedside variant, CRB-65, omits urea — useful when no labs are available.
Score Components (mnemonic: CURB-65)
- C — Confusion (new, or AMTS ≤ 8)
- U — Urea > 7 mmol/L (BUN > 19 mg/dL or ~ blood urea > 40 mg/dL)
- R — Respiratory rate ≥ 30/min
- B — Blood pressure (SBP < 90 or DBP ≤ 60 mmHg)
- 65 — Age ≥ 65 years
Disposition by Score (BTS + ICS India)
- 0–1: Low mortality (<3%) — outpatient treatment. Oral amoxicillin ± macrolide.
- 2: Moderate risk (9%) — hospitalise, consider short-stay or ward.
- 3–5: High risk (15–57%) — inpatient with strong consideration of ICU/HDU.
Always override the score if SpO₂ < 92% on room air, bilateral/multilobar infiltrates, lactate > 2, decompensated comorbidity, or unreliable home situation.
Empirical Antibiotics — ICS India + ICMR AMR 2022
- Outpatient: Amoxicillin 1g TDS × 5–7d (~₹60 course) ± Azithromycin 500mg OD × 3d (~₹50).
- Ward: Co-amoxiclav 1.2g IV TDS (~₹270/day) + Azithromycin 500mg OD IV/PO.
- ICU: Ceftriaxone 2g IV OD (~₹120/day) + Azithromycin 500mg OD; OR Piperacillin-tazobactam 4.5g Q8H (~₹1,350/day) if Pseudomonas risk (structural lung disease, prior IV antibiotics, recent hospitalisation).
- Atypical cover: Macrolide or doxycycline (₹15/day) — essential in India due to high Mycoplasma/Chlamydia/Legionella rates.
- Influenza season: Add oseltamivir 75mg BD × 5d (~₹500 course) empirically when ILI prevalence is high.
When NOT to use CURB-65
- Hospital-acquired or ventilator-associated pneumonia (HAP/VAP) — use IDSA HAP/VAP criteria.
- Immunocompromised hosts (HIV, post-transplant, neutropenia, on biologics).
- Aspiration pneumonia in nursing-home residents (use a broader antibiotic spectrum).
- Active pulmonary TB — high prevalence in India; always screen with sputum AFB/CBNAAT.
- Severe COVID-19 pneumonia — use 4C Mortality, WHO clinical progression, or NEWS2 instead.
Frequently Asked Questions
▸What is the difference between CURB-65 and CRB-65?
CRB-65 drops the urea variable, making it suitable for primary care or rural OPD where labs are not immediately available. Mortality risk increases at CRB-65 ≥ 1 (refer) and ≥ 2 (urgent admission).
▸My patient has SpO₂ 88% on room air but CURB-65 is 0 — outpatient OK?
No. CURB-65 does not include oxygenation. Any patient with SpO₂ < 92% on room air should be admitted regardless of CURB-65 — this is an explicit ICS India and BTS over-ride.
▸Why is BUN > 19 mg/dL but Indian labs report blood urea?
Indian labs typically report blood urea, not BUN. Blood urea > 42 mg/dL (= 7 mmol/L) meets the cut-off. Some texts use blood urea > 40 mg/dL as a practical threshold.
▸What antibiotic course duration in India?
ICS India and ICMR 2022 recommend 5 days for mild CAP if afebrile by 48–72 hours and clinically stable. Severe/bacteremic CAP, S. aureus, or Pseudomonas: 7–14 days. Longer courses do not reduce relapse and drive resistance.
▸Should I use CURB-65 or PSI/PORT?
PSI is more accurate for identifying truly low-risk patients (PSI class I–II safe to discharge), but it has 20 variables. CURB-65 is faster, simpler, and equally good at identifying high-risk patients. Most Indian EDs use CURB-65 as the default; PSI as a secondary check before discharge.
▸Does CURB-65 work for COVID-19 pneumonia?
It under-estimates severity in COVID-19 because hypoxia is the dominant feature, not BP or confusion. Use the 4C Mortality Score, NEWS2, or simply SpO₂/FiO₂ ratio for COVID-19 triage.
References
- Lim WS et al. Defining community acquired pneumonia severity on presentation to hospital: CURB-65. Thorax 2003;58(5):377-82
- BTS Guidelines for the Management of Community Acquired Pneumonia in Adults — Annotated 2015 update
- Metlay JP et al. IDSA/ATS Clinical Practice Guideline on CAP. Am J Respir Crit Care Med 2019
- Indian Chest Society + National College of Chest Physicians (NCCP) Consensus Guidelines on CAP, 2012
- ICMR Treatment Guidelines for Antimicrobial Use in Common Syndromes, 2022 — Pneumonia chapter
Pneumonia decisions, structured at the point of care
EasyClinic auto-computes CURB-65, PSI, and SMART-COP from vitals + labs already in the chart, recommends ICS-India guideline antibiotics with ₹ pricing, and prints a discharge plan with red-flag instructions in regional languages.
Trusted by Indian doctors who want to stop typing
Choose the plan that fits your practice — cancel anytime.
DOCTORSCRIBE
AI Medical Scribe
₹999
/month
- ✓ Voice → prescription in 30 seconds
- ✓ 11 Indian languages (Hindi, Tamil, Telugu, etc.)
- ✓ Auto pediatric dose by weight
- ✓ ICD-10 codes, drug interactions
EASYCLINIC
Complete Clinic Platform
₹1,999
/month
- ✓ Everything in DoctorScribe, plus:
- ✓ Patient records, billing, GST invoices
- ✓ WhatsApp reminders to patients
- ✓ Multi-doctor scheduling + analytics
- ✓ All 60+ calculators built into the chart