title: Low CURB-65 is of limited value in deciding discharge of patients with community-acquired pneumonia.
abstract: BACKGROUND
  The relationship between clinical judgment and indications of the CURB-65 score in deciding the site-of-care for patients with community-acquired pneumonia (CAP) has not been fully investigated. The aim of this study was to evaluate reasons for hospitalization of CAP patients with CURB-65 score of 0 and 1.
  
  
  METHODS
  An observational, retrospective study of consecutive CAP patients was performed at the Fondazione Cà Granda, Milan, Italy, between January 2005 and December 2006. The medical records of hospitalized patients with CAP having a CURB-65 score of 0 and 1 were identified and reviewed to determine whether there existed a clinical basis to justify hospitalization.
  
  
  RESULTS
  Among the 580 patients included in the study, 218 were classified with a CURB-65 score of 0 or 1. Among those, 127 were hospitalized, and reasons that justified hospitalization were found in 104 (83%) patients. Main reasons for hospitalization included the presence of hypoxemia on admission (35%), failure of outpatient therapy (14%) and the presence of cardiovascular events on admission (9.7%). Used as the sole indicator for inappropriate hospitalization, the CURB-65 score had a poor positive predictive value of 52%.
  
  
  CONCLUSIONS
  Although the CURB-65 has been proposed as a tool to guide the site of care decision by international guidelines, this score is not ideal by itself, and should not be regarded as providing decision support information if a score of 0 and 1 is present. In CAP patients with CURB-65 scores of 0 or 1, further evaluations should be performed and completed by clinical judgment.
authors.affiliation: Dipartimento di Medicina Clinica e Prevenzione, University of Milan-Bicocca, Clinica pneumologica, AO San Gerardo, Via Pergolesi 33, 20052 Monza, Italy.stefano.aliberti@unimib.it
authors.forename: Stefano
authors.initials: S
authors.lastname: Aliberti
authors.forename: Julio
authors.initials: J
authors.lastname: Ramirez
authors.forename: Roberto
authors.initials: R
authors.lastname: Cosentini
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Brambilla
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Zanaboni
authors.forename: Valeria
authors.initials: V
authors.lastname: Rossetti
authors.forename: Paolo
authors.initials: P
authors.lastname: Tarsia
authors.forename: Paula
authors.initials: P
authors.lastname: Peyrani
authors.forename: Federico
authors.initials: F
authors.lastname: Piffer
authors.forename: Francesco
authors.initials: F
authors.lastname: Blasi
mesh_terms: D000368:Aged; D002755:Choice Behavior; D017714:Community-Acquired Infections / Q000175:diagnosis; D003657:Decision Making; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011014:Pneumonia / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index