Community-Acquired Pneumonia (CAP) — Disposition Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] CURB-65 severity assessment
   CURB-65 score? (1 point each: C new-onset confusion · U urea >7 mmol/L · R respiratory rate ≥30 · B blood pressure (SBP <90 or DBP ≤60) · age ≥65. Use CRB-65 if urea is unavailable. Always also screen high scorers for sepsis / hypoxemia.)
   • 0–1 (low risk) → Outpatient treatment
   • 2 (intermediate) → Consider admission / observation
   • 3–5 (high risk) → Admit · does it meet ICU criteria?
2. [End] Outpatient treatment
   Low risk (0–1, 30-day mortality <3%): usually manageable as an outpatient with empiric oral antibiotics (chosen for local resistance and risk factors). Ensure follow-up, repeat assessment and safety-net advice; first check for concurrent hypoxemia, sepsis or unstable comorbidities.
3. [End] Consider admission / observation
   Intermediate risk (2 points, mortality ~9%): consider a short admission or observation with supervised treatment, individualized to stability and comorbidities. Give empiric antibiotics and assess oxygen need.
4. [Decision] Admit · does it meet ICU criteria?
   Does it meet severe-CAP (IDSA/ATS) criteria? (Major criteria (either → ICU): respiratory failure requiring mechanical ventilation; septic shock requiring vasopressors. Minor criteria (≥3 → consider ICU): RR ≥30, PaO2/FiO2 ≤250, multilobar infiltrates, confusion, uremia, leukopenia, thrombocytopenia, hypothermia, hypotension requiring aggressive fluids, etc.)
   • Meets ICU criteria (≥1 major or ≥3 minor) → Severe CAP → ICU
   • Does not meet ICU criteria → General ward admission
5. [End] Severe CAP → ICU
   ICU care: organ support (mechanical ventilation / vasopressors); empiric broad-spectrum antibiotics covering atypicals (per local resistance and risk factors; cover Pseudomonas / MRSA if indicated); microbiology (blood/sputum cultures, urinary antigens, respiratory viral PCR); assess complications (empyema, ARDS). Run the sepsis bundle in parallel.
6. [End] General ward admission
   Inpatient empiric antibiotics + oxygen + microbiology + monitoring; reassess response at 48–72 h and escalate evaluation and repeat imaging if no improvement or deterioration.

Source guidelines & references

• IDSA/ATS 2019 Guideline on the diagnosis and treatment of adults with CAP. Am J Respir Crit Care Med 2019 · source ↗
• Lim WS, et al. CURB-65. Thorax 2003

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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