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    SMART-COP Score for Pneumonia Severity

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

    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
    Pearls/Pitfalls
    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.
    ≤50
    >50

    Result:

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    Next Steps
    Evidence
    Creator Insights

    Advice

    • Patients who do not meet criteria for ICU admission using the SMART-COP Score should still be evaluated for the need for inpatient admission.
    • They should also receive timely and appropriate empiric antibiotics for CAP, generally a beta-lactam plus a macrolide, or a fluoroquinolone.
    • Goals of care and other variables may recommend against ICU admission even if the SMART-COP Score is high.

    Critical Actions

    For patients with high SMART-COP Scores, consider broadening antibiotic regimen to include MRSA coverage (for ICU admission, necrotizing or cavitary infiltrates, or empyema, previous MRSA infection) and/or to include antipseudomonal coverage (for history of structural lung disease, immunocompromise, or previous Pseudomonas infection). Also, consider if the patient has associated sepsis and treat accordingly.

    Content Contributors
    • Jennifer Chen, MD
    About the Creator
    Dr. Patrick Charles
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    Content Contributors
    • Jennifer Chen, MD