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    SMART-COP Score for Pneumonia Severity

    Predicts need for intensive respiratory or vasopressor support (IRVS) in community-acquired pneumonia (CAP).


    Tips for COVID-19: Use to determine floor vs. ICU. Perhaps best performing to predict ICU admissions for CAP, but unclear applicability in COVID/viral pneumonias/ARDS.


    Use in patients ≥18 years with clinical and radiographic findings consistent with community acquired pneumonia (CAP). Does not apply to patients with significant immunosuppression.

    When to Use
    Why Use

    Patients with CAP who may require ICU care.

    • The SMART-COP Score for Pneumonia Severity was developed to identify patients at increased risk for intensive respiratory or vasopressor support (IRVS).
    • Can help stratify which patients need ICU admission.
    • Does not estimate mortality.
    • Includes age-adjusted cutoffs for respiratory rate and oxygen levels, but otherwise does not explicitly include patient age as a variable, in contrast with PSI or CURB-65 scores. This may preserve the positive predictive value with advancing age.
    • CAP is the single most common cause of sepsis in older patients, but can be difficult to recognize due to blunted fever and tachycardic responses to infection.
    • Consideration of other variables not included in the SMART-COP Score, such as comorbidities, functional status, frailty, and physician gestalt, may still recommend ICU admission.
    • Uses readily available patient information.
    • Can help identify which patients need ICU admission, with 92.3% sensitivity, 62.3% specificity, and an AUC of 0.87, leading to better utilization of resources and treatment initiation.
    • Delayed admission to the ICU is associated with higher 30-day mortality in patients with CAP (Restrepo 2010).
    • Performs comparably well with the 2007 IDSA/ATS guidelines’ minor criteria.
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    Creator Insights
    Dr. Patrick Charles

    About the Creator

    Patrick Charles, MBBS, FRACP, Ph.D, is a practicing infectious disease physician at Austin Health in Victoria, Australia. He is also the head of the general medicine unit and an honorary lecturer at the University of Melbourne. Dr. Charles researches the emergence of antibiotic-resistant pathogens, community-acquired pneumonia, and urinary bacteriotherapy, among other infectious disease topics.

    To view Dr. Patrick Charles's publications, visit PubMed

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    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
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    About the Creator
    Dr. Patrick Charles
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