title: CURB-65 pneumonia severity assessment adapted for electronic decision support.
abstract: BACKGROUND
  Accurate severity assessment is crucial to the initial management of community-acquired pneumonia (CAP). The CURB-65 (confusion, uremia, respiratory rate, BP, age ≥ 65 years) score contains data that are entered routinely in electronic medical records and are, thus, electronically calculable. The aim of this study was to determine whether an electronically generated severity estimate using CURB-65 elements as continuous and weighted variables better predicts 30-day mortality than the traditional CURB-65.
  
  
  METHODS
  In a retrospective cohort study at a US university-affiliated community teaching hospital, we identified 2,069 patients aged 18 years or older with CAP confirmed by radiographic findings in the ED. CURB-65 elements were extracted from the electronic medical record, and 30-day mortality was identified with the Utah Population Database. Performance of a severity prediction model using continuous and weighted CURB-65 variables was compared with the traditional CURB-65 in the US derivation population and validated in the original 1,048 patients from the CURB-65 international derivation study.
  
  
  RESULTS
  The traditional, binary CURB-65 score predicted mortality in the US cohort with an area under the curve (AUC) of 0.82. Our severity prediction model generated from continuous, weighted CURB-65 elements was superior to the traditional CURB-65, with an out-of-bag AUC of 0.86 (P < .001). This finding was validated in the international database, with an AUC of 0.85 for the electronic model compared with 0.80 for the traditional CURB-65 (P = .01).
  
  
  CONCLUSIONS
  Using CURB-65 elements as continuous and weighted data improved prediction of 30-day mortality and could be used as a real-time, electronic decision support tool or to adjust outcomes by severity when comparing processes of care.
authors.affiliation: Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT. Electronic address: barbara.jones@hsc.utah.edu.
authors.forename: Barbara E
authors.initials: BE
authors.lastname: Jones
authors.affiliation: Department of Medical Informatics, Intermountain Medical Center, Murray, UT.
authors.forename: Jason
authors.initials: J
authors.lastname: Jones
authors.affiliation: Nottingham University Hospitals NHS Trust, Nottingham, England.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bewick
authors.affiliation: Nottingham University Hospitals NHS Trust, Nottingham, England.
authors.forename: Wei Shen
authors.initials: WS
authors.lastname: Lim
authors.affiliation: Department of Biomedical Informatics and Emergency Medicine, Vanderbilt Hospital, Nashville, TN.
authors.forename: Dominik
authors.initials: D
authors.lastname: Aronsky
authors.affiliation: Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT; Department of Medical Informatics, Intermountain Medical Center, Murray, UT.
authors.forename: Samuel M
authors.initials: SM
authors.lastname: Brown
authors.affiliation: Department of Pulmonary Disease, Medical Centre Alkmaar, The Netherlands.
authors.forename: Wim G
authors.initials: WG
authors.lastname: Boersma
authors.affiliation: Department of Pulmonary Disease, Medical Centre Alkmaar, The Netherlands.
authors.forename: Menno M
authors.initials: MM
authors.lastname: van der Eerden
authors.affiliation: Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City, UT; Department of Medical Informatics, Intermountain Medical Center, Murray, UT.
authors.forename: Nathan C
authors.initials: NC
authors.lastname: Dean
mesh_terms: D017714:Community-Acquired Infections / Q000175:diagnosis* / Q000453:epidemiology; D003661:Decision Support Techniques; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis* / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D014589:Utah / Q000453:epidemiology