The SMART-COP score performs well for pneumonia risk stratification in Australia's Tropical Northern Territory

A prospective cohort study

Karen L. Robins-Browne, Allen C. Cheng, Kathleen A S Thomas, Didier J. Palmer, Bart J. Currie, Joshua S. Davis

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objective: To prospectively compare a modified pneumonia severity scoring system, SMARTACOP, with other severity scores in patients presenting with pneumonia to the emergency department (ED) of a tertiary referral hospital in tropical Australia.

Methods: We conducted a prospective observational study of adult patients presenting with radiologically confirmed pneumonia over a 12-month period. The sensitivity of risk stratification scores were assessed against the need for intensive respiratory or vasopressor support (IRVS).

Results: There were 367 ED attendances for pneumonia of whom 77.1% were admitted to hospital, 10% required intensive respiratory or vasopressor support and 2.8% died. Mean age was 50.0years, 52% were men and 59% were Indigenous. The sensitivity of a SMART-COP score ≥3, a SMARTACOP score ≥3 and a pneumonia severity index (PSI) class ≥3 for predicting IRVS was 97%, 97% and 78% respectively.

Conclusions: We found no significant advantage of the SMARTACOP over the SMART-COP score for the prediction of intensive respiratory or vasopressor support, but both scores significantly outperformed PSI. The SMART-COP score should replace the PSI in tropical Australia and should be assessed in other tropical areas for pneumonia risk stratification in emergency departments.

Original languageEnglish
Pages (from-to)914-919
Number of pages6
JournalTropical Medicine and International Health
Volume17
Issue number7
DOIs
Publication statusPublished - Jul 2012

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Northern Territory
Pneumonia
Cohort Studies
Prospective Studies
Hospital Emergency Service
Observational Studies
Referral and Consultation

Cite this

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title = "The SMART-COP score performs well for pneumonia risk stratification in Australia's Tropical Northern Territory: A prospective cohort study",
abstract = "Objective: To prospectively compare a modified pneumonia severity scoring system, SMARTACOP, with other severity scores in patients presenting with pneumonia to the emergency department (ED) of a tertiary referral hospital in tropical Australia. Methods: We conducted a prospective observational study of adult patients presenting with radiologically confirmed pneumonia over a 12-month period. The sensitivity of risk stratification scores were assessed against the need for intensive respiratory or vasopressor support (IRVS). Results: There were 367 ED attendances for pneumonia of whom 77.1{\%} were admitted to hospital, 10{\%} required intensive respiratory or vasopressor support and 2.8{\%} died. Mean age was 50.0years, 52{\%} were men and 59{\%} were Indigenous. The sensitivity of a SMART-COP score ≥3, a SMARTACOP score ≥3 and a pneumonia severity index (PSI) class ≥3 for predicting IRVS was 97{\%}, 97{\%} and 78{\%} respectively. Conclusions: We found no significant advantage of the SMARTACOP over the SMART-COP score for the prediction of intensive respiratory or vasopressor support, but both scores significantly outperformed PSI. The SMART-COP score should replace the PSI in tropical Australia and should be assessed in other tropical areas for pneumonia risk stratification in emergency departments.",
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The SMART-COP score performs well for pneumonia risk stratification in Australia's Tropical Northern Territory : A prospective cohort study. / Robins-Browne, Karen L.; Cheng, Allen C.; Thomas, Kathleen A S; Palmer, Didier J.; Currie, Bart J.; Davis, Joshua S.

In: Tropical Medicine and International Health, Vol. 17, No. 7, 07.2012, p. 914-919.

Research output: Contribution to journalArticleResearchpeer-review

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AU - Robins-Browne, Karen L.

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N2 - Objective: To prospectively compare a modified pneumonia severity scoring system, SMARTACOP, with other severity scores in patients presenting with pneumonia to the emergency department (ED) of a tertiary referral hospital in tropical Australia. Methods: We conducted a prospective observational study of adult patients presenting with radiologically confirmed pneumonia over a 12-month period. The sensitivity of risk stratification scores were assessed against the need for intensive respiratory or vasopressor support (IRVS). Results: There were 367 ED attendances for pneumonia of whom 77.1% were admitted to hospital, 10% required intensive respiratory or vasopressor support and 2.8% died. Mean age was 50.0years, 52% were men and 59% were Indigenous. The sensitivity of a SMART-COP score ≥3, a SMARTACOP score ≥3 and a pneumonia severity index (PSI) class ≥3 for predicting IRVS was 97%, 97% and 78% respectively. Conclusions: We found no significant advantage of the SMARTACOP over the SMART-COP score for the prediction of intensive respiratory or vasopressor support, but both scores significantly outperformed PSI. The SMART-COP score should replace the PSI in tropical Australia and should be assessed in other tropical areas for pneumonia risk stratification in emergency departments.

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