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Original Research: CHEST INFECTIONS |

CURB-65 Pneumonia Severity Assessment Adapted for Electronic Decision SupporteCURB Electronic Pneumonia Severity Tool

Barbara E. Jones, MD; Jason Jones, PhD; Thomas Bewick, MD; Wei Shen Lim, MD; Dominik Aronsky, MD, PhD; Samuel M. Brown, MD; Wim G. Boersma, MD; Menno M. van der Eerden, MD; Nathan C. Dean, MD, FCCP
Author and Funding Information

From the Department of Medicine, Division of Pulmonary and Critical Care Medicine (Drs B. E. Jones, Brown, and Dean), University of Utah, Salt Lake City, UT; the Department of Medical Informatics (Drs J. Jones, Brown, and Dean), Intermountain Medical Center, Murray, UT; the Nottingham University Hospitals NHS Trust (Drs Bewick and Lim), Nottingham, England; the Department of Biomedical Informatics and Emergency Medicine (Dr Aronsky), Vanderbilt Hospital, Nashville, TN; and the Department of Pulmonary Disease (Drs Boersma and van der Eerden), Medical Centre Alkmaar, The Netherlands.Dr van der Eerden is currently as the Erasmus Center (Rotterdam, The Netherlands).

Correspondence to: Barbara E. Jones, MD, Division of Pulmonary and Critical Care Medicine, University of Utah, 26 N 1900 E, Wintrobe Bldg, Room 701, Salt Lake City, UT 84132; e-mail: barbara.jones@hsc.utah.edu


Funding/Support: This research is supported by the Deseret Foundation of Salt Lake City, UT.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(1):156-163. doi:10.1378/chest.10-1296
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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.

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