What is the CRUB-65 (Confusion, Respiratory rate, Urine output, Blood pressure, and age 65 or older) score used for in pneumonia assessment?

From the Guidelines

The CRUB-65 score is a crucial tool for assessing the severity of community-acquired pneumonia, guiding treatment decisions, and determining the need for hospitalization or intensive care. The CRUB-65 score evaluates five key factors: Confusion, Respiratory rate, Urea, Blood pressure, and age 65 or older, with each factor scoring one point when abnormal, creating a total score from 0-5. According to the most recent and highest quality study [ 1 ], patients with scores of 0-1 are generally suitable for outpatient treatment, scores of 2 indicate consideration for short hospital stays or supervised outpatient care, and scores of 3-5 suggest the need for hospitalization, with scores of 4-5 often requiring ICU admission. Some key points to consider when using the CRUB-65 score include:

• The score is a valuable aid in avoiding inappropriate admissions of low-mortality-risk patients [ 1 ]
• Clinical judgment should always complement the score, especially for patients with comorbidities or other concerning features not captured by the CRUB-65 criteria [ 1 ]
• The CRUB-65 score has been shown to outperform generic sepsis and early warning scores in terms of prediction of death from pneumonia [ 1 ]
• Biomarkers such as CRP or PCT may have a significant potential to improve severity assessment, but their use is still limited by the available evidence [ 1 ] In clinical practice, the CRUB-65 score should be used as a tool to guide treatment decisions, but not as the sole determinant of treatment, with clinical judgment and consideration of individual patient factors playing a crucial role in determining the best course of care [ 1 ].

From the Research

CRUB-65 Score Overview

• The CRUB-65 score is a severity score used to assess patients with community-acquired pneumonia (CAP) 2, 3, 4, 5, 6.
• The score is based on five components: Confusion, Respiratory rate, Urine output (or Urea), Blood pressure, and age 65 or older.

Components of the CRUB-65 Score

• Confusion: presence of confusion or altered mental status
• Respiratory rate: ≥ 30 breaths per minute
• Urine output (or Urea): < 0.5 mL/kg/hour (or Urea > 7 mmol/L)
• Blood pressure: systolic < 90 mmHg or diastolic ≤ 60 mmHg
• Age: ≥ 65 years

Use of the CRUB-65 Score

• The CRUB-65 score is used to predict in-hospital death and intensive care unit (ICU) need in patients with CAP 2, 3.
• The score can be used to identify low-risk patients who may not require hospitalization or ICU admission 2, 3.
• The CRUB-65 score has been validated in various studies and has been shown to be a useful tool for predicting mortality and ICU need in patients with CAP 2, 3, 4, 5, 6.

Comparison with Other Scoring Systems

• The CRUB-65 score has been compared with other scoring systems, such as the Pneumonia Severity Index (PSI) and the modified American Thoracic Society (mATS) rule 3, 5.
• The CRUB-65 score has been shown to be easier to use and more practical than the PSI, but may not be as sensitive or specific 3, 5.

Electronic Decision Support

• The CRUB-65 score can be adapted for electronic decision support, using continuous and weighted variables to improve prediction of 30-day mortality 6.
• Electronic decision support tools using the CRUB-65 score may be useful for real-time prediction of mortality and adjustment of outcomes by severity 6.