Pneumonia Severity Assessment (CURB-65)

When to Use This Skill

Use when a clinician needs to determine pneumonia severity and appropriate level of care using validated scoring tools.

Clinical Workflow

1. Use fhir_read to retrieve Patient demographics (age for scoring)
2. Use fhir_search to pull vital signs: BP (8480-6), respiratory rate (9279-1), temperature (8310-5), heart rate (8867-4), SpO2 (2708-6)
3. Use fhir_search to pull labs: BUN (3094-0), WBC (6690-2), creatinine (2160-0), glucose (2345-7), pH (2744-1), PaO2 (2703-7), albumin (1751-7), sodium (2951-2), hematocrit (4544-3)
4. Use fhir_search to pull active Condition resources for comorbidities and confirmed pneumonia diagnosis
5. Use fhir_search to pull DiagnosticReport for chest imaging results
6. Calculate CURB-65 score (see references/curb65-scoring.md)
7. If data sufficient, also calculate PSI/PORT score for more granular risk stratification
8. Present severity classification with disposition recommendation and antibiotic guidance

FHIR Resources

• Patient -- Age, gender
• Observation -- Vitals and labs for scoring
• Condition -- Pneumonia diagnosis, comorbidities (CHF, liver disease, renal disease, cerebrovascular disease, malignancy)
• DiagnosticReport -- Chest X-ray or CT findings (pleural effusion, multilobar involvement)

FHIR Query Examples

Pull Vitals

fhir_search(resourceType="Observation", queryParams="patient=[patient-id]&category=vital-signs&_sort=-date&_count=10")

Pull BUN

fhir_search(resourceType="Observation", queryParams="patient=[patient-id]&code=3094-0&_sort=-date&_count=1")

Clinical Guidelines

• ATS/IDSA 2019 Community-Acquired Pneumonia Guidelines
• BTS Guidelines for CAP (CURB-65 origin)
• IDSA/ATS criteria for severe CAP requiring ICU admission

Interpretation Guide

• CURB-65: 0-1 outpatient treatment, 2 consider short inpatient or supervised outpatient, 3-5 inpatient (4-5 consider ICU)
• PSI/PORT: Class I-III outpatient, Class IV inpatient, Class V ICU consideration
• ATS/IDSA major criteria for ICU: septic shock requiring vasopressors, mechanical ventilation
• ATS/IDSA minor criteria (>=3 = ICU): RR >=30, PaO2/FiO2 <=250, multilobar infiltrates, confusion, BUN >=20, WBC <4000, platelets <100K, temperature <36C, hypotension requiring aggressive fluids

Safety

• Never fabricate clinical data -- only report what FHIR returns
• Flag critical/abnormal values immediately
• Scope all FHIR queries to the authenticated patient
• Use standard terminology (LOINC, SNOMED CT, RxNorm, ICD-10)
• Present data in clinician-friendly format with reference ranges