🫁 SMART-COP (CAP Intensive-Support Prediction)
SMART-COP predicts the need for intensive respiratory or vasopressor support (IRVS) in community-acquired pneumonia, with age-adjusted respiratory and oxygenation thresholds.
SMART-COP (CAP Intensive-Support Prediction)
Age (yr)
Systolic BP < 90 mmHg
Multilobar involvement on chest X-ray
Albumin < 35 g/L
Respiratory rate (/min)
Heart rate ≥ 125 bpm
Acute confusion
Oxygenation index type
Oxygenation value
Arterial pH < 7.35
When to use
Enter age, then the eight components; the tool scores 0–11 and bands the IRVS risk. A score ≥ 3 should prompt consideration of high-dependency or ICU evaluation.
How it works
Points: SBP<90 (2), multilobar (1), albumin<35 (1), HR≥125 (1), confusion (1), pH<7.35 (2), tachypnea (≤50 yr ≥25 / >50 yr ≥30: 1), hypoxemia (≤50 yr PaO₂<70/SpO₂≤93/PF<333; >50 yr <60/≤90/<250: 2). Bands: 0–2 low · 3–4 moderate (~1/8) · 5–6 high (~1/3) · ≥7 very high (~2/3).
Key points
- Unlike CURB-65 (which predicts mortality), SMART-COP predicts the need for intensive organ support, making it more decision-oriented for triage to ICU. (original synthesis · not guideline verbatim)
- The respiratory-rate and oxygenation cutoffs differ by age (≤50 vs >50), so the same physiology scores differently in younger patients.
- It is a prediction aid, not a disposition mandate; integrate trajectory, comorbidity, and response to initial therapy.
References
- Charles PG, et al. SMART-COP: a tool for predicting the need for intensive respiratory or vasopressor support in CAP. Clin Infect Dis. 2008;47(3):375-384.
- Metlay JP, et al. Diagnosis and Treatment of Adults with Community-acquired Pneumonia (ATS/IDSA). Am J Respir Crit Care Med. 2019;200(7):e45-e67.
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.