More on pneumonia: Clinical judgment is also needed with CURB score

doi:10.1136/bmj.332.7553.1333-a

BMJ 2006;332:1333 (3 June), doi:10.1136/bmj.332.7553.1333-a

Letter

Clinical judgment is also needed with CURB score

The first 150 words of the full text of this article appear below.

EDITOR—Commendably, Owen et al are committed to reducinginappropriate intravenous antibiotic prescribing but we areconcerned by some of their assumptions.¹ Although the guidelinesfrom the British Thoracic Society state that patients with aCURB-65 score of 0 or 1 are likely to be suitable for home treatment,Hoare and Lim have recognised that clinical judgment is alsoneeded.² Similarly, recent guidance from the Department of Healthand Health Protection Agency on the management of Panton-Valentineleukocidin associated staphylococcal pneumonia has stated thatCURB-65 may be misleadingly low in fit young adults.³ In a studyin our own institution over the last year (in preparation) fiveof 40 patients with a CURB-65 score of 1 at presentation requiredcare in a high dependency unit or intensive care unit.

We would be concerned if blind adherence to a score designedfor mortality prognostication without reference to the currentor . . . [Full text of this article]

Kirsty Challen, research fellow, emergency medicine

kirsty.challen@smtr.nhs.uk, South Manchester University Hospitals Trust, Manchester M23 9LT

Darren Walter, clinical director, emergency medicine, John Bright, specialist registrar, respiratory medicine, Andrew Bentley, consultant, respiratory medicine and critical care

South Manchester University Hospitals Trust, Manchester M23 9LT