Pulmonology Book

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Pneumonia IRVS Prediction Tool

Aka: Pneumonia IRVS Prediction Tool, CAP IRVS Prediction Tool, Community Acquired Pneumonia Intensive Respiratory or Vasopressor Support Prediction Tool, SMART-COP
  1. See Also
    1. Community Acquired Pneumonia
    2. Community Acquired Pneumonia Management
  2. Indications
    1. Community Acquired Pneumonia assessment of severity
  3. Background
    1. SMART-COP is acronym for
      1. Systolic Blood Pressure
      2. Multilobar involvement
      3. Albumin
      4. Respiratory Rate
      5. Tachycardia
      6. Confusion
      7. Oxygen level
      8. pH (arterial)
  4. Criteria
    1. Major findings (2 points each)
      1. Systolic Blood Pressure <90 mmHg
      2. Oxygen level low
        1. Age <50 years
          1. paO2 <70 mmHg
          2. paO2/FIO2 ratio <333 if on oxygen
          3. Oxygen Saturation <94%
        2. Age >=50 years
          1. paO2 <60 mmHg
          2. paO2/FIO2 ratio <250 if on oxygen
          3. Oxygen Saturation <91%
    2. Minor findings (1 point each)
      1. Multilobar involvement on Chest XRay
      2. Respiratory Rate
        1. Age 50 or younger: >25 breaths/min
        2. Age over 50 years: >30 breaths/min
      3. Tachycardia with Heart Rate >125 beats/min
      4. New onset of confusion
    3. Lab findings (1 point each)
      1. Serum Albumin <3.5 g/dl
      2. Arterial pH <7.35
  5. Interpretation: General
    1. Scoring predicts need for Intensive Respiratory or Vasopressor Support (IRVS)
  6. Interpretation: Clinic based where lab criteria not available (does not include lab findings above)
    1. Score 0 points: Very low risk of IRVS
    2. Score 1 points: Low risk of IRVS
    3. Score 2 points: Moderate risk of IRVS (1 in 10 patients)
    4. Score 3 points: High risk of IRVS (1 in 6 patients)
    5. Score 4 points: Very high risk of IRVS (1 in 3 patients)
  7. Interpretation: Standard scoring including lab findings
    1. Score 0-2 points: Low risk of IRVS
    2. Score 3-4 points: Moderate risk of IRVS (1 in 8 patients)
    3. Score 5-6 points: High risk of IRVS (1 in 3 patients)
    4. Score 7 points: Very high risk of IRVS (2 in 3 patients)
  8. Resources
    1. LifeInTheFastLane PDF Guidelines
      1. http://cdn.lifeinthefastlane.com/wp-content/uploads/2010/07/etg-smartcop.pdf
  9. References
    1. Charles (2008) Clin Infect Dis 47(3): 375-84 [PubMed]

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