referral criteria from primary care - community acquired pneumonia

Last reviewed 06/2021

• clinical judgement is essential in disease severity assessment of community acquired pneumonia (CAP):
  
  
  • stability of any comorbid illness and a patient's social circumstances should be considered when assessing disease severity
  • severity assessment of CAP in patients seen in the community
    
    
    • for all patients, clinical judgement supported by the CRB65 score should be applied when deciding whether to treat at home or refer to hospital
      
      
      • CRB65 score
        • one point is awarded for each of the following features:
          • Confusion - recent
          • Respiratory rate 30 breaths/min or greater
          • Blood pressure - systolic of 90 mmHg or less or a diastolic of 60 mmHg or less
          • 65 years of age or older
            
            
      • patients who have a CRB65 score of 0 are at low risk of death and do not normally require hospitalisation for clinical reasons
        
        
      • patients who have a CRB65 score of 1 or 2 are at increased risk of death, particularly with a score of 2, and hospital referral and assessment should be considered
        
        
      • patients who have a CRB65 score of 3 or more are at high risk of death and require urgent hospital admission
        
        
    • when deciding on home treatment, the patient's social circumstances and wishes must be taken into account in all instance
      
      
• pulse oximetry in CAP
  • if available, use pulse oximetry to assess the severity of people with suspected pneumonia and other acute respiratory illnesses
    • people with oxygen saturation < 92% require admission to hospital

Reference:

• 1) British Thoracic Society. Guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax 2009;64 (Suppl III):1-55.