関: 肺炎、A-DROP

項目

Confusion　　　　　：意識障害あり
Urea　　　　　　　　：BUN＞20mg/dl
Respiratory rate　　：呼吸回数≧30回/分
low Blood pressure　：SBP＜90mmHgまたはDBP＜60mmHg
age 65　　　　　　　：年齢≧65歳

判定

2項目以上該当すれば、入院または注意深い外来フォローが必要

WordNet

keep to the curb; "curb your dogs"
a horses bit with an attached chain or strap to check the horse (同)curb bit
an edge between a sidewalk and a roadway consisting of a line of curbstones (usually forming part of a gutter) (同)curbing, kerb

PrepTutorEJDIC

(馬の)くつわ鎖,止めぐつわ / 拘束,抑制 / 《米》(歩道を車道と区分するため縁にそって並べた)縁石(《英》kerb) / (止めぐつわで)〈馬〉'を'制御する / 〈感情・欲望など〉'を'抑制する

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/11/09 16:50:01」(JST)

wiki en

[Wiki en表示]

CURB-65
Symptom	Points
Confusion	1
BUN>7 mmol/l	1
Respiratory rate>=30	1
SBP<90mmHg, DBP=<60mmHg	1
Age>=65	1

CURB-65, also known as the CURB criteria, is a clinical prediction rule that has been validated for predicting mortality in community-acquired pneumonia^[1] and infection of any site.^[2] The CURB-65 is based on the earlier CURB score^[3] and is recommended by the British Thoracic Society for the assessment of severity of pneumonia.^[4] It was developed in 2002 at the University of Nottingham by Dr. W.S. Lim et al.^[1]

The score is an acronym for each of the risk factors measured. Each risk factor scores one point, for a maximum score of 5:

Confusion of new onset (defined as an AMTS of 8 or less)
Blood Urea nitrogen greater than 7 mmol/l (19 mg/dL)
Respiratory rate of 30 breaths per minute or greater
Blood pressure less than 90 mmHg systolic or diastolic blood pressure 60 mmHg or less
age 65 or older

Predicting death

Pneumonia

The risk of death at 30 days increases as the score increases:^[1]

0—0.6%
1—2.7%
2—6.8%
3—14.0%
4—27.8%
5—27.8%

The CURB-65 has been compared to the pneumonia severity index in predicting mortality from pneumonia.^[5] It was shown that the PSI has a higher discriminatory power for short-term mortality, and thus is more accurate for low risk patients than the CURB-65 or its predecessor, the CURB score.^[3] However, the PSI is more complicated and requires arterial blood gas sampling amongst other tests; given this, the CURB-65 score is more easily used in primary care settings.^[6] A variant of the CURB-65 that omits the urea measurement (CRB-65)^[6] is even simpler, as it relies only on history and examination findings rather than blood tests.

The CURB-65 is used as a means of deciding the action that is needed to be taken for that patient.

0-1: Treat as an outpatient
2: Consider a short stay in hospital or watch very closely as an outpatient
3-5: Requires hospitalization with consideration as to whether they need to be in the intensive care unit

Any infection

Patients with any type of infection (half of the patients had pneumonia), the risk of death increases as the score increases:^[2]

0 to 1 <5% mortality
2 to 3 < 10% mortality
4 to 5 15-30% mortality

References

^ ^a ^b ^c Lim WS, van der Eerden MM, Laing R; et al. (2003). "Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study". Thorax 58 (5): 377–82. doi:10.1136/thorax.58.5.377. PMC 1746657. PMID 12728155.
^ ^a ^b Howell MD, Donnino MW, Talmor D, Clardy P, Ngo L, Shapiro NI (2007). "Performance of severity of illness scoring systems in emergency department patients with infection". Academic Emergency Medicine 14 (8): 709–14. doi:10.1197/j.aem.2007.02.036. PMID 17576773.
^ ^a ^b Lim WS, Macfarlane JT, Boswell TC; et al. (2001). "Study of community acquired pneumonia aetiology (SCAPA) in adults admitted to hospital: implications for management guidelines". Thorax 56 (4): 296–301. doi:10.1136/thorax.56.4.296. PMC 1746017. PMID 11254821.
^ British Thoracic Society Standards of Care Committee (2001). "BTS Guidelines for the Management of Community Acquired Pneumonia in Adults". Thorax. 56. Suppl 4: IV1–64. doi:10.1136/thx.56.suppl_4.iv1. PMC 1765992. PMID 11713364.
^ Aujesky D, Auble TE, Yealy DM; et al. (2005). "Prospective comparison of three validated prediction rules for prognosis in community-acquired pneumonia". Am. J. Med. 118 (4): 384–92. doi:10.1016/j.amjmed.2005.01.006. PMID 15808136.
^ ^a ^b Ebell MH. (2006). "Outpatient vs. inpatient treatment of community acquired pneumonia.". Fam Pract Manag 13 (4): 41–4. PMID 16671349.

UpToDate Contents

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1. 成人における市中肺炎：リスクの層別化と入院の決定 community acquired pneumonia in adults risk stratification and the decision to admit
2. 計算ツール：CURB-65肺炎重症度スコア calculator curb 65 pneumonia severity score
3. 成人における市中肺炎の予後 prognosis of community acquired pneumonia in adults
4. 成人の外来患者における市中肺炎の治療 treatment of community acquired pneumonia in adults in the outpatient setting
5. 入院を要する成人における市中肺炎の治療 treatment of community acquired pneumonia in adults who require hospitalization

English Journal

The role of pneumonia scores in the emergency room in patients infected by 2009 H1N1 infection.

Brandão-Neto RA, Goulart AC, Santana AN, Martins HS, Ribeiro SC, Ho LY, Chiamolera M, Magri MM, Scalabrini-Neto A, Velasco IT.SourceEmergency Department, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil.
European journal of emergency medicine : official journal of the European Society for Emergency Medicine.Eur J Emerg Med.2012 Jun;19(3):200-2.
Despite the severity of pneumonia in patients with pandemic influenza A infection (H1N1), no validated risk scores associated with H1N1 pneumonia were tested. In this prospective observational study, we analyzed data of consecutive patients in our emergency room, hospitalized because of pneumonia be
PMID 21785358

An audit of inpatient management of community-acquired pneumonia in Oman: A comparison with regional clinical guidelines.

Al-Abri SS, Al-Maashani S, Memish ZA, Beeching NJ.SourceRoyal Hospital, Muscat, Oman.
Journal of infection and public health.J Infect Public Health.2012 Jun;5(3):250-6. Epub 2012 Apr 20.
OBJECTIVE: Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality worldwide. Herein, we present the findings from an audit of CAP management at a tertiary hospital in Oman. The main objective was to evaluate the quality of care given to patients and compare it with the standa
PMID 22632599

Japanese Journal

The definition of healthcare-associated pneumonia (HCAP) is insufficient for the medical environment in Japan : a comparison of HCAP and nursing and healthcare-associated pneumonia (NHCAP)

Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy 19(1), 70-76, 2013-02-01
NAID 10031155821

Refeeding syndromeのリスクを有する重症肺炎患者の早期経腸栄養療法に関わる因子の検討

静脈経腸栄養 28(2), 653-660, 2013
NAID 130004487294

Elevated Blood Urea Nitrogen Is a Predictive Factor for Intensive Care Unit Admission in Legionella Pneumonia

北関東医学 62(3), 251-254, 2012-08
NAID 120004606893

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