Last reviewed May 6, 2026 by NPBoardSlay Medical Review Board

CURB-65

Pneumonia Severity (CAP)

One point each. 0-1 home · 2 admit · 3+ think ICU.

What this mnemonic does is take a community-acquired pneumonia vignette and turn it into a one-line disposition decision. CURB-65 scores one point each for new Confusion, Urea over 19 (BUN over 7 mmol/L), Respiratory rate 30 or higher, Blood pressure under 90 systolic or 60 diastolic, and age 65 or older. 0-1 is outpatient, 2 admits, 3 or higher considers ICU. The AANP exam uses CURB-65 to test admission criteria — a 70-year-old with confusion and tachypnea does not go home with azithromycin, regardless of how sick they look on exam. Pneumonia severity index is more granular but CURB-65 is what boards rewards.

C
Confusion
New-onset disorientation (to person, place, or time).
U
Urea (BUN) >19 mg/dL
Trip-wire: it is BUN, not creatinine.
R
Respiratory rate ≥30
Tachypnea signals decompensation.
B
Blood pressure
SBP <90 or DBP ≤60.
65
Age ≥65
Older patients have higher mortality independent of other factors.

Clinical Context

Validated severity score for community-acquired pneumonia. 0-1 = outpatient (mortality <3%); 2 = short admission; 3+ = ICU consideration (mortality 15-40%). CRB-65 (no urea) is a common clinic-only version when labs are not immediately available.

CURB-65 decides disposition (where to treat), not empiric antibiotics (what to start). The AANP loves pairing the score with a disposition question — "this 72-year-old with confusion, RR 32, and BUN 25 should be..." triage accordingly.