When should I consider referring a patient with aspiration pneumonia to secondary care?

Consider referring a patient with aspiration pneumonia to secondary care if they have a CRB65 score of 2 or more, indicating intermediate to high risk of mortality within 30 days. This includes patients who present with any of the following: confusion (new disorientation), a respiratory rate of 30 breaths per minute or more, low blood pressure (systolic <90 mmHg or diastolic ≤60 mmHg), or age 65 years or older.

Also consider referral if the patient shows signs of clinical deterioration, inability to eat without assistance, oxygen saturation under 90% on room air, abnormal mental status, or if they have significant comorbidities or immunosuppression that may worsen their condition.

Use clinical judgement alongside the CRB65 score to decide on hospital assessment, and discuss care options with patients scoring 1 to make a shared decision.