Birth weight and adult lung function

Since the maximum possible score becomes 7, we defined severe pneumonia as a score >4 for the CURB-age criteria compared with >3 for CURB-65. The subjects were 189 patients (median age 75 years, range 17–96, 56.1% men) who were included in two prospective observational studies of CAP. Detailed methodology has been reported previously. 5 Using CURB-65 there were 109 non-severe cases (57.7%) and 80 severe cases (42.3%) and by CURB-age criteria there were 125 non-severe cases (66.1%) and 64 severe cases (33.9%). There were 5 deaths in each of the non-severe groups and 22 deaths in each of the severe groups. We examined the sensitivity, specificity, positive predictive values (PPV) and negative predictive values (NPV) of 6 week mortality and their corresponding 95% Pearson-Clopper exact confidence intervals for both CURB-65 and CURBage criteria (table 1). The CURB-age criteria showed a significantly higher specificity (p = 0.0001, McNemar test). A simple modification improves the specificity and PPV without losing the sensitivity of CURB-65 criteria and without requiring any additional information. It is as simple as CURB-65 and provides higher accuracy in identifying those who died over SOAR and CURB-65 criteria with significantly higher specificity. We combined the data from two cohorts of patients with CAP from two time periods, with the second cohort being elderly patients only (>65 years). It is reassuring that the CURB-age criteria better identified severe pneumonia in this older cohort. In the study in which the CURB-65 criteria were developed and validated, the median age of patients was 64 years. Our findings have important clinical implications. The current BTS guidelines recommend that severe CAP should be treated with intravenous antibiotics. These are more likely to produce untoward side effects such as antibiotic-associated diarrhoea than oral antibiotics, especially in older adults, and their use should be limited to truly severe CAP in older patients. Although the number of patients in our study is comparable to the original validation cohort reported by Lim et al (189 vs 214), larger studies are needed to test the validity of these modified criteria.