Emergency Medicine

BREATHLESS PATIENT

General Medical Emergencies 69

Table 2.6 SMART-COP score for assessing severity, once community-acquired
pneumonia is confirmed on CXR

Score

S Systolic BP <90 mmHg

M Multi-lobar CXR involvement

A Albumen <35 g/L

R Respiratory rate – age-adjusted cut-offs:

Age ≤50 yr >50 yr

RR ≥25/min ≥30/min

T Tachycardia ≥125/min

C Confusion (new onset)

O Oxygen low – age-adjusted cut-offs:

Age ≤50 yr >50 yr

PaO 2 <70 mmHg <60 mmHg

or SaO 2 ≤93% ≤90%

or (if on O 2 ) PaO 2 /FiO 2 <333 <250

P Arterial pH <7.35

2 points

1 point

1 point

1 point

1 point

1 point

2 points

2 points

TOTAL SCORE =

(Max 11)

0–2 points: Low risk of needing IRVS
3–4 points: Moderate (1 in 8) risk of needing IRVS
5–6 points: High (1 in 3) risk of needing IRVS
≥7 points: Very high (2 in 3) risk of needing IRVS
A score of ≥5 indicates severe CAP.
BP, blood pressure; CAP, community-acquired pneumonia; CXR, chest x-ray; FiO 2 ,
fractional inspired oxygen concentration; IRVS, intensive respiratory or vasopressor
support; PaO 2 , partial pressure of oxygen (arterial); RR, respiratory rate; SaO 2 , arterial
oxygen saturation.
Adapted with permission from Charles PG, Wolfe R, Whitby M et al. (2008)
SMART-COP: a tool for predicting the need for intensive respiratory or vasopressor
support in community-acquired pneumonia. Clinical Infectious Diseases 47 : 375–84.

MANAGEMENT

1 Give the patient high-dose oxygen, unless there is a known history of

obstructive airways disease (use 28%). Aim for an oxygen saturation above

92%.

2 Start antibiotics according to the severity of the pneumonia, and or based on

local guidelines.