A 75-year-old patient with community-acquired pneumonia presents with temperature of 102.1, chills, productive cough, BP 90/5062, WBC 12,000, and blood urea nitrogen (BUN) 20 mg/dl
He has a history of mild dementia and his mental status is unchanged from his last visit. These findings indicate that the patient:
A. Can be treated as an outpatient
B. Requires hospitalization for treatment
C. Requires a high dose of parenteral antibiotic
D. Can be treated with oral antibiotics
ANS: A
Decision Rule: CURB-65 provides framework for determining whether the patient diagnosed with community-acquired pneumonia can be safely monitored and treated at home. One point is awarded for each of the following factors present:
• Confusion of new onset
• BUN is greater than 20mg/dl
• Respiratory rate of ??30 breaths/minute
• Blood pressure is less than 90 mmHg systolic or diastolic ??60 mm Hg
• Age 65 or older
Patients scoring 3 to 5 typically require hospitalization for observation and therapy. Scores of 0 to 1 indicate likelihood that outpatient management is appropriate. A score of 2 is inconclusive.
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