Which patient with community-acquired pneumonia is most likely to require hospitalization based on CURB-65 criteria?

• A. 84-year-old man with pneumonia; temperature 37.9°C; pulse 92/min; respirations 28/min; blood pressure 110/58 mmHg; oxygen saturation 92% on room air.
• B. 60-year-old woman with shortness of breath for 6 hours; temperature 37.0°C; pulse 104/min; respirations 18/min; blood pressure 132/94 mmHg; oxygen saturation 95% on room air; no confusion; no urea measurement.
• C. 75-year-old man with pneumonia; respirations 34/min; systolic blood pressure 92 mmHg; diastolic 50 mmHg; oxygen saturation 88%; age ≥65; no data on confusion or urea.
• D. 68-year-old man with pneumonia; respirations 32/min; systolic blood pressure 120 mmHg; diastolic 66 mmHg; oxygen saturation 95% on room air; age ≥65; no confusion; no urea measurement.

Answer: (C)

This question tests how CURB-65 risk scoring guides whether a patient with pneumonia should be hospitalized. CURB-65 awards one point for each of five factors: confusion, elevated urea, respiratory rate of 30 or more, low blood pressure (systolic <90 or diastolic ≤60), and age 65 or older. A total score of 2 or more generally prompts admission, with higher scores indicating greater risk.

Evaluating each patient: the 84-year-old has age plus a diastolic blood pressure of 58, giving two points. The 60-year-old has none of the criteria, so zero points. The 75-year-old has a respiratory rate of 34 (one point), diastolic BP 50 (one point), and age 75 (one point), totaling three points. The 68-year-old has a respiratory rate of 32 (one point) and age 68 (one point), for two points.

The highest CURB-65 score is three for the 75-year-old, indicating the greatest need for hospitalization. The notably low oxygen saturation (88%) supports the severity but isn’t itself a CURB-65 criterion. Hence, the patient with rapid breathing, low diastolic pressure, and advanced age is most likely to require admission.