SynthesisThe British journal of general practice : the journal of the Royal College of General Practitioners2010
Validity of British Thoracic Society guidance (the CRB-65 rule) for predicting the severity of pneumonia in general practice: systematic review and meta-analysis.
Synthesis in The British journal of general practice : the journal of the Royal College of General Practitioners, 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 39 papers, 5 of them syntheses that pooled it.
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Who cites it
39 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- Initial assessment and management of adults with suspected acute respiratory infection: a rapid evidence synthesis of reviews and cost-effectiveness studies.Health technology assessment (Winchester, England) · 2026Pooled it
- Pooled it
- Meta-analysis of Calibration, Discrimination, and Stratum-Specific Likelihood Ratios for the CRB-65 Score.Journal of general internal medicine · 2019Pooled it
- Clinical gestalt to diagnose pneumonia, sinusitis, and pharyngitis: a meta-analysis.The British journal of general practice : the journal of the Royal College of General Practitioners · 2019Pooled it
- When should acute exacerbations of COPD be treated with systemic corticosteroids and antibiotics in primary care: a systematic review of current COPD guidelines.NPJ primary care respiratory medicine · 2015Pooled it
- Hybrid Telemedicine-House-Call Model for Pneumonia Management in North Texas: Retrospective Pilot Study.JMIR formative research · 2026Article
- Article
- Predicting 7-day mortality in COVID-19 pneumonia: performance of NEWS2, qSOFA, and CRB-65 and development of the CCP-7 prediction scores.IJID regions · 2025Article
- At-home validation of a non-contact, radar-based breathing monitor for long-term care of patients with respiratory diseases: A proof-of-concept study.Pneumologie (Stuttgart, Germany) · 2025Article
- The SpOJournal of clinical medicine · 2024Article
- Management and documentation of pneumonia - a comparison of patients consulting primary care and emergency care.Scandinavian journal of primary health care · 2024Article
- Prognostic accuracy of eight triage scores in suspected COVID-19 in an Emergency Department low-income setting: An observational cohort study.African journal of emergency medicine : Revue africaine de la medecine d'urgence · 2024Article
- Identifying Existing Evidence to Potentially Develop a Machine Learning Diagnostic Algorithm for Cough in Primary Care Settings: Scoping Review.Journal of medical Internet research · 2023Article
- Low CRB-65 Scores Effectively Rule out Adverse Clinical Outcomes in COVID-19 Irrespective of Chest Radiographic Abnormalities.Biomedicines · 2023Article
- Long-Term Impact of a Smartphone App on Prescriber Adherence to Antibiotic Guidelines for Adult Patients With Community-Acquired Pneumonia: Interrupted Time-Series Study.Journal of medical Internet research · 2023Article
- Acute management of pneumonia in adult patients.Singapore medical journal · 2023Article
- CRB-65 for Risk Stratification and Prediction of Prognosis in Pulmonary Embolism.Journal of clinical medicine · 2023Article
- The role of a noninvasive index 'Spo2/ Fio2' in predicting mortality among patients with COVID-19 pneumonia.The American journal of emergency medicine · 2022Article
- Mallampati Score Is an Independent Predictor of Active Oxygen Therapy in Patients with COVID-19.Journal of clinical medicine · 2022Article
- External Validation of the Modified 4C Deterioration Model and 4C Mortality Score for COVID-19 Patients in a Swiss Tertiary Hospital.Diagnostics (Basel, Switzerland) · 2022Article
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Authors and funding
5 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundThe CRB-65 score is a clinical prediction rule that grades the severity of community-acquired pneumonia in terms of 30-day mortality.
aimThe study sought to validate CRB-65 and assess its clinical value in community and hospital settings. DESIGN OF STUDY: Systematic review and meta-analysis of validation studies of CRB-65.
methodMedline (1966 to June 2009), Embase (1988 to November 2008), British Nursing Index (BNI) and PsychINFO were searched, using a diagnostic accuracy search filter combined with subject-specific terms. The derived (index) rule was used as a predictive model and applied to all validation studies. Comparison was made between the observed and predicted number of deaths stratified by risk group (low, intermediate, and high) and setting of care (community or hospital). Pooled results are presented as risk ratios (RRs) in terms of over-prediction (RR>1) or under-prediction (RR<1) of 30-day mortality.
resultsFourteen validation studies totalling 397 875 patients are included. CRB-65 performs well in hospitalised patients, particularly in those classified as intermediate (RR 0.91, 95% confidence interval [CI] = 0.71 to 1.17) or high risk (RR 1.01, 95% CI = 0.87 to 1.16). In community settings, CRB-65 over-predicts the probability of 30-day mortality across all strata of predicted risk, low (RR 9.41, 95% CI = 1.75 to 50.66), intermediate (RR 4.84, 95% CI = 2.61 to 8.69), and high (RR 1.58, 95% CI = 0.59 to 4.19).
conclusionCRB-65 performs well in stratifying severity of pneumonia and resultant 30-day mortality in hospital settings. In community settings, CRB-65 appears to over-predict the probability of 30-day mortality across all strata of predicted risk. Caution is needed when applying CRB-65 to patients in general practice.
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