SMART-COP
Predicts need for intensive respiratory or vasopressor support in community-acquired pneumonia.
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Why use it
Better than CURB-65 and PSI for identifying patients who need ICU-level respiratory or vasopressor support, even if not initially presenting in shock.
About
SMART-COP predicts the need for intensive respiratory or vasopressor support (IRVS) in community-acquired pneumonia. An acronym for Systolic BP, Multilobar CXR, Albumin, RR, Tachycardia, Confusion, Oxygenation, and pH.
When to use
- Adults hospitalized with community-acquired pneumonia
- Deciding on ICU vs. ward admission
- Identifying patients who may deteriorate and need IRVS
- Complementary to CURB-65 and PSI
Formula
S — SBP <90 mmHg: +2
M — Multilobar CXR infiltrates: +1
A — Albumin <3.5 g/dL: +1
R — RR ≥25 (<50yr) or ≥30 (≥50yr): +1
T — Tachycardia HR ≥125 bpm: +1
C — Confusion (new): +1
O — Poor oxygenation (age-adjusted): +2
P — pH <7.35: +2
Total: 0-11
Pearls & pitfalls
- IRVS = mechanical ventilation OR vasopressors.
- Age-adjusted oxygenation: SpO₂ <93% or PaO₂/FiO₂ <250 (<333 if ≥50 years).
- Albumin <3.5 g/dL scores 1 point — useful in elderly/malnourished.
- Validated in Australian multicenter cohort (n=882).
Next steps
Score ≥5: 90% specificity for needing IRVS — consider ICU or HDU. Score 3-4: moderate risk — close monitoring. Score 0-2: low risk of IRVS.
Evidence
Charles et al. Clin Infect Dis 2008. AUC 0.87 for predicting need for IRVS. Validated externally in multiple cohorts.
References
- Charles PGP et al. SMART-COP: a tool for predicting the need for intensive respiratory or vasopressor support in community-acquired pneumonia. Clin Infect Dis. 2008;47(3):375-384. — link