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Pneumonia risk stratification in tropical Australia: does the SMART-COP score apply?

Davis, Joshua S., Cross, Gail B., Charles, Patrick, Currie, Bart J., Anstey, Nicholas M. and Cheng, Allen C. (2010). Pneumonia risk stratification in tropical Australia: does the SMART-COP score apply?. Medical Journal of Australia,192(3):133-136.

Document type: Journal Article
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IRMA ID 81704288xPUB37
Title Pneumonia risk stratification in tropical Australia: does the SMART-COP score apply?
Author Davis, Joshua S.
Cross, Gail B.
Charles, Patrick
Currie, Bart J.
Anstey, Nicholas M.
Cheng, Allen C.
Journal Name Medical Journal of Australia
Publication Date 2010
Volume Number 192
Issue Number 3
ISSN 0025-729X   (check CDU catalogue open catalogue search in new window)
Start Page 133
End Page 136
Total Pages 4
Place of Publication Australia
Publisher Australasian Medical Publishing Company Pty. Ltd.
HERDC Category C1 - Journal Article (DIISR)
Abstract 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.

, 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.

: 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.

: The SMART-COP score underestimates the severity of pneumonia in tropical northern Australia, but can be improved by using locally relevant additions.

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