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.",
    keywords = "Critical illness, Emergency service, Pneumonia, Tropical medicine",
    author = "Robins-Browne, {Karen L.} and Cheng, {Allen C.} and Thomas, {Kathleen A S} and Palmer, {Didier J.} and Currie, {Bart J.} and Davis, {Joshua S.}",
    year = "2012",
    month = "7",
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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

    TY - JOUR

    T1 - The SMART-COP score performs well for pneumonia risk stratification in Australia's Tropical Northern Territory

    T2 - A prospective cohort study

    AU - Robins-Browne, Karen L.

    AU - Cheng, Allen C.

    AU - Thomas, Kathleen A S

    AU - Palmer, Didier J.

    AU - Currie, Bart J.

    AU - Davis, Joshua S.

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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.

    AB - 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.

    KW - Critical illness

    KW - Emergency service

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