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Referral criteria from primary care - community acquired pneumonia

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

  • 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


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