A 72-year-old woman with advanced motor neurone disease presents to A&E with a 3-day history of worsening breathlessness, fever, and acute confusion.
On examination her respiratory rate is 28, peripheral oxygen saturations 95% on 2L nasal cannula, heart rate 107, blood pressure 104/58, temperature 38.2°C

Auscultation reveals reduced air entry at both bases and coarse inspiratory crepitations in the left lower zone. GCS: 13 (E4V3M6).  

Chest X-ray reveals bibasal atelectasis and left lower zone patchy consolidation

Bloods reveal the following

||||
|--------------|:-------:|---------------|
|Haemoglobin|118  g/L|(M) 130 - 170, (F) 115 - 155|
|White Cell Count|17.1x10<sup>9</sup>/L|3.0 - 10.0|
|Urea|11.1 mmol/L|2.5 - 7.8|
|Creatinine|170 µmol/L|60 - 120|
|C Reactive Protein|135 mg/L|< 5|


What of the following is the patient's calculated CURB-65 score?

Options:
explanation: CURB-65 is made up of five components, all scoring either 0 or 1: confusion, urea >7mmol/L, respiratory rate ≥ 30, systolic BP < 90 mmHg or diastolic BP ≤ 60 mmHg , and age ≥ 65. This patient scores for all sections except respiratory rate, therefore she scores 4, putting her in the highest risk group with 27.8 30-day mortality
name: 1
label: b
answer: no
explanation: CURB-65 is made up of five components, all scoring either 0 or 1: confusion, urea >7mmol/L, respiratory rate ≥ 30, systolic BP < 90 mmHg or diastolic BP ≤ 60 mmHg , and age ≥ 65. It's purpose is to estimate mortality for community-acquired pneumonia to help determine whether they should be managed as an inpatient or outpatient i.e. whether to admit them. CURB-65 score 0-1 assigns them to a low risk group with 2.7% 30-day mortality where they can likely be managed as an outpatient. Score 2 assigns them to moderate risk group with 6.8% 30-day mortality where they should either be managed as an inpatient or as an outpatient with close follow-up. Score 3 assigns them to severe risk group with 14.0% 30-day mortality where they should be admitted with possible intensive care admission. Score 4-5 puts them in the highest risk group with 27.8% 30-day mortality where they should be admitted with possible intensive care admission. This patient scores for all sections except respiratory rate, therefore she scores 4, putting her in the highest risk group
name: 4
label: a
answer: yes
explanation: CURB-65 is made up of five components, all scoring either 0 or 1: confusion, urea >7mmol/L, respiratory rate ≥ 30, systolic BP < 90 mmHg or diastolic BP ≤ 60 mmHg , and age ≥ 65. This patient scores for all sections except respiratory rate, therefore she scores 4, putting her in the highest risk group with 27.8 30-day mortality
name: 2
label: c
answer: no
explanation: CURB-65 is made up of five components, all scoring either 0 or 1: confusion, urea >7mmol/L, respiratory rate ≥ 30, systolic BP < 90 mmHg or diastolic BP ≤ 60 mmHg , and age ≥ 65. This patient scores for all sections except respiratory rate, therefore she scores 4, putting her in the highest risk group with 27.8 30-day mortality
name: 3
label: d
answer: no
explanation: CURB-65 is made up of five components, all scoring either 0 or 1: confusion, urea >7mmol/L, respiratory rate ≥ 30, systolic BP < 90 mmHg or diastolic BP ≤ 60 mmHg , and age ≥ 65. This patient scores for all sections except respiratory rate, therefore she scores 4, putting her in the highest risk group with 27.8 30-day mortality
name: 5
label: e
answer: no

Correct answer: a

4