Pneumonia: two scores, one question
Educational use only. Not clinically reviewed62-year-old man for calm reconciliation of two instruments, critical-care activation, bounded escalation intent, reassessment, and handoff practice. About 8 simulated minutes.
What you will practise
- Reconcile two supplied instruments that are both correct and disagree.
- Recognize that one instrument answers a different question.
- Activate critical-care review while the patient is still on a ward trajectory.
- Review the triage evidence boundary.
- Record bounded escalation intent, then reassess a strict later report.
- Hand off a pending level-of-care decision and active risk.
Review and sources
Not clinically reviewed. No clinician has signed this scenario.
- Metlay JP, Waterer GW, Long AC, et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia. An Official Clinical Practice Guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Respir Crit Care Med. 2019;200(7):e45-e67. Severe CAP major and minor criteria; three or more minor criteria define severe pneumonia. The 2025 ATS update did not revise the severity definition, and IDSA did not endorse that update.
- National Institute for Health and Care Excellence. Pneumonia: diagnosis and management. NICE guideline NG250. Published 2025-09-02, replacing NG138 and NG139 and partially replacing CG191. CURB65 supports place-of-care decisions alongside clinical judgement rather than in isolation; a score of 3 or more indicates inpatient care with referral to critical care services if appropriate.
- Marti C, Garin N, Grosgurin O, et al. Prediction of severe community-acquired pneumonia: a systematic review and meta-analysis. Crit Care. 2012;16:R141. Pooled discrimination of about 0.69 for CURB-65 and PSI in predicting critical-care admission; severity criteria and purpose-built tools discriminate better.
Open Sim Lab is an educational simulator, not for clinical use. It is not a clinical decision-support tool, not a dosing calculator, and is not validated for any decision affecting a real patient.