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. Design, setting and patients: A prospective observational stu...

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Bibliographic Details
Published in:Medical journal of Australia 2010-02, Vol.192 (3), p.133-136
Main Authors: Davis, Joshua S, Cross, Gail B, Charles, Patrick G P, Currie, Bart J, Anstey, Nicholas M, Cheng, Allen C
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Australia
Biological and medical sciences
Community-Acquired Infections - diagnosis
Community-Acquired Infections - etiology
Community-Acquired Infections - therapy
Female
General aspects
Humans
Indigenous health
Infectious diseases
Male
Medical sciences
Middle Aged
Pneumonia - diagnosis
Pneumonia - etiology
Pneumonia - therapy
Predictive Value of Tests
Prospective Studies
Respiration, Artificial
Risk Assessment
Severity of Illness Index
Tropical Climate
Vasoconstrictor Agents - therapeutic use
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Summary: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. Design, setting and patients: 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 ≥ 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 (SMARTACOP) that used a higher weighting for albumin and included Indigenous status. A SMARTACOP score of ≥ 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.
ISSN:0025-729X
1326-5377
DOI:10.5694/j.1326-5377.2010.tb03450.x