This analysis presents an urgent public policy issue of whether such elevated risk in smaller delivery units is acceptable or if further consolidation of birthing units should be considered to reduce early-neonatal mortality.

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C(U)RB-65 (confusion, (urea .7 mol?L -1 ,) respiratory frequency o30 breaths?min -1 , systolic blood pressure ,90 mmHg or diastolic blood pressure f60 mmHg and age o65 years) is now the generally accepted severity score for patients with community-acquired pneumonia (CAP) in Europe.In an observational study based on the large database from the German nationwide performance measurement programme in healthcare quality, including data from all hospitalised patients with CAP during 2008-2010, different CRB-age groups (o50 and o60 years) across the total CAP population and three entities of CAP (younger population aged ,65 years, patients aged o65 years not residing in nursing homes and those with nursing home-acquired pneumonia (NHAP)) were validated for their potential to predict in-hospital death.660 594 patients were investigated. Mortality was n593 958 (14.0%). In the total population, CRB-80 had the optimal area under the curve (0.690, 95% CI 0.688-0.691). However, in the younger cohort, CRB-50 performed best (0.730, 95% CI 0.724-0.736), with good identification of low-risk patients (CRB-50 risk class 1: 1.28% deaths, negative predictive value 98.7%). In the elderly, CRB-80 as the optimal age group performed worse (0.663, 95% CI 0.660-0.655 in patients not residing in nursing homes; 0.608, 95% CI 0.605-0.611 in those with NHAP). In the latter group, all CRB-age groups failed to identify low-risk patients (CRB-80 risk class 1: 22.75% deaths, negative predictive value 81.8%).Patients with hospitalised CAP aged ,65 years may be assessed by the CRB-50 score. In those aged o65 years (not NHAP) assessed by the CRB-65 score, low-risk patients are already are at an increased risk of death. In NHAP patients, even the use of CRB-80 does not identify low-risk patients and should be accompanied by the evaluation of functional status and comorbidity.

This is the largest population-based, risk-adjusted analysis to be carried out on this topic to date. It reveals, for the first time, an association between DDI of 20 minutes or less and the avoidance of outcomes that are dangerous to the child. As it is not possible to predict such obstetrical emergencies in advance, it seems reasonable to ensure the availability of caredelivery structures that make it possible for emergency cesarean sections to be performed within 20 minutes of the decision to do so.