CRB-65 for the assessment of pneumonia severity: who could ask for more?

Abstract

It is intriguing that such a simple rule is able to predict the risk of death so accurately. Nevertheless, in this issue of Thorax, Chalmers and colleagues8 provide convincing data from a large population showing that the CRB-65 score can be simplified even more by omitting diastolic blood pressure 65 years, the presence of new onset pneumonia associated mental confusion, hypotension with systolic blood pressure 30/min, applying 1 point for each criterion met, with assignment to risk class 1 for those with no points, risk class 2 for those with 1 or 2 points and risk class 3 for those with 3 or 4 points. Patients meeting risk class 1 would be ideal candidates for ambulatory treatment in the absence of any severe decompensated comorbidity, pneumonia related complication (such as large pleural effusion) or social factors requiring hospital care. The additional simplification achieved by Chalmers and colleagues8 is important because increasing simplicity of a prediction rule increases its chance of being accepted and applied in everyday practice.