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 50.0 years, 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.
authors.affiliation: Royal Darwin Hospital, Darwin, NT, Australia.
authors.forename: Karen L
authors.initials: KL
authors.lastname: Robins-Browne
authors.forename: Allen C
authors.initials: AC
authors.lastname: Cheng
authors.forename: Kathleen A S
authors.initials: KA
authors.lastname: Thomas
authors.forename: Didier J
authors.initials: DJ
authors.lastname: Palmer
authors.forename: Bart J
authors.initials: BJ
authors.lastname: Currie
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Davis
mesh_terms: D000328:Adult; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000175:diagnosis*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015876:Northern Territory; D011014:Pneumonia / Q000175:diagnosis*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index