Pneumonia risk stratification in tropical Australia: does the SMART-COP score apply?
OBJECTIVE
To examine the performance in tropical northern Australia of SMART-COP, a simple scoring system developed in temperate Australia to predict the need for intensive respiratory or vasopressor support (IRVS) in pneumonia patients.


METHODS
A prospective observational study of patients admitted to Royal Darwin Hospital in the Northern Territory with sepsis between August 2007 and May 2008. Chest x-rays were reviewed to confirm pneumonia, and each patient's SMART-COP score was assessed against the need for IRVS.


RESULTS
Of 206 patients presenting with radiologically confirmed pneumonia, 184 were eligible for inclusion. The mean age of patients was 50.1 years, 65% were Indigenous and 56% were men. Overall, 38 patients (21%) required IRVS, and 18 patients (10%) died by Day 30. A SMART-COP score of >or= 3 had a sensitivity of only 71% for predicting the need for IRVS and 67% for 30-day mortality. As the variables most strongly associated with IRVS were serum albumin level < 35 g/L (odds ratio, 6.8) and Indigenous status (odds ratio, 2.3), we tested a modified scoring system (SMART-COP) that used a higher weighting for albumin and included Indigenous status. A SMART-COP score of >or= 3 had a sensitivity of 97% for IRVS and 100% for 30-day mortality.


CONCLUSIONS
The SMART-COP score underestimates the severity of pneumonia in tropical northern Australia, but can be improved by using locally relevant additions.
Davis
Joshua S
JS
Menzies School of Health Research and Charles Darwin University, Darwin, NT. Joshua.Davis@menzies.edu.au
Cross
Gail B
GB
Charles
Patrick G P
PG
Currie
Bart J
BJ
Anstey
Nicholas M
NM
Cheng
Allen C
AC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012121:Respiration, Artificial; D018570:Risk Assessment; D012720:Severity of Illness Index; D014329:Tropical Climate; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D014662:Vasoconstrictor Agents