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Chest infections - adult - Management
When should I admit or refer a person with pneumonia to secondary care?
- Assess the CRB-65 score for all people diagnosed with pneumonia. One point is awarded for each of the following features: Confusion — recent; Respiratory rate of 30 breaths/min or greater; Blood pressure — systolic of 90 mmHg or less or diastolic of 60 mmHg or less; and 65 years old or older. (However, other factors should also be considered when making the decision to admit).
- For people with a CRB-65 score of 3 or more, arrange urgent admission to hospital.
- For people with a CRB-65 score of 2, arrange same-day assessment in secondary care. Secondary care options include short-stay inpatient treatment or hospital-supervised outpatient treatment.
- For people with a CRB-65 score of 1, consider arranging same-day assessment in secondary care.
- For people with a CRB-65 score of 0, treatment at home is usually appropriate, depending on clinical judgement (for example the stability of any comorbid illness) and available social support.
- If available, use pulse oximetry to assess the severity of people with suspected pneumonia and other acute respiratory illnesses.
- People with oxygen saturation less than 92% require admission to hospital.
- For people over the age of 50 years who smoke and do not require admission to hospital, check for possible underlying lung cancer by:
- Assessing for clinical features of underlying lung cancer.
- Arranging a chest X-ray at the time of presentation.
- Arranging a follow-up chest X-ray at 6 weeks if the initial X-ray does not detect an underlying malignancy (see Follow up).
- Refer urgently (within 2 weeks) if there are any clinical or radiographic features of lung cancer.
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