This is an unprecedented time. It is the dedication of healthcare workers that will lead us through this crisis. Thank you for everything you do.

      Calc Function

    • Calcs that help predict probability of a diseaseDiagnosis
    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
    • Disease is diagnosed: prognosticate to guide treatmentPrognosis
    • Numerical inputs and outputsFormula
    • Med treatment and moreTreatment
    • Suggested protocolsAlgorithm





    Chief Complaint


    Organ System


    Patent Pending

    SMART-COP Score for Pneumonia Severity

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


    We launched a COVID-19 Resource Center, including a critical review of recommended calcs.

    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.
    Confirmed positive
    Confirmed negative


    Please fill out required fields.

    Next Steps
    Creator Insights


    • 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
    Are you Dr. Patrick Charles?
    Content Contributors
    • Jennifer Chen, MD