Charles et al developed a decision tool for identifying a patient with community-acquired pneumonia who is likely to require intensive respiratory and/or vasopressor support. The authors are from multiple hospitals in Australia.
Parameters:
(1) systolic blood pressure
(2) infiltrate on chest X-ray
(3) serum albumin
(4) respiratory rate
(5) heart rate
(6) confusion
(7) oxygenation
(8) arterial pH
|
Parameter |
Finding |
Points |
|
systolic blood pressure |
normal or high |
0 |
|
|
low (hypotension, < 90 mm Hg) |
2 |
|
infiltrate on chest X-ray |
single lobe infiltrate |
0 |
|
|
multi-lobar |
1 |
|
serum albumin |
normal or high |
0 |
|
|
low (< 3.5 g/dL) |
1 |
|
respiratory rate |
low or normal |
0 |
|
|
high (tachypnea, see below) |
1 |
|
heart rate |
low or normal |
0 |
|
|
high (tachycardia, >= 125 beats/min) |
1 |
|
new onset of confusion |
absent |
0 |
|
|
present |
1 |
|
oxygenation |
good |
0 |
|
|
poor (hypoxia, see below)) |
2 |
|
arterial pH |
normal or high |
0 |
|
|
low (acidosis; pH < 7.35) |
2 |
where:
• Tachypnea was defined as >= 25 breaths per minute for a patient <= 50 years old and >= 30 breaths per minute for a patient > 50 years old.
• Hypoxia for a patient <= 50 years was defined by one of the following: a PaO2 < 70 mm Hg (presumably on room air), PaO2 to FIO2 ratio < 333 or arterial oxygen saturation <= 93%.
• Hypoxia for a patient > 50 years was defined by one of the following: a PaO2 < 60 mm Hg (presumably on room air) , PaO2 to FIO2 ratio < 250 or arterial oxygen saturation <= 90%.
• The acronym SMART-COP was derived from the first letters for systolic, multilobar, albumin, respiratory, tachycardia, confusion, oxygenation, pH.
total score =
= SUM(points for all 8 parameters)
Interpretation:
• minimum score: 0
• maximum score: 11
• The higher the score the more severe the pneumonia.
• A score >= 3 identifies 92% of patients requiring intensive respiratory and/or ventilatory support.
Purpose: To identify a patient with community-acquired pneumonia who will need intensive respiratory and/or vasopressor support based on the tool of Charles et al.
Specialty: Infectious Diseases, Pulmonology
Objective: severity, prognosis, stage, disease progression, referral and transfer
ICD-10: J12, J13, J14, J15, J16, J17, J18,
