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Validity of SMART-COP score in prognosis and severity of community acquired pneumonia in the emergency department

  • Author Footnotes
    1 Study design, supervisor, critical revising.
    Babak Ehsanpoor
    Footnotes
    1 Study design, supervisor, critical revising.
    Affiliations
    Tehran University of Medical Sciences, Shariati Hospital, Emergency Medicine Research Center, Tehran, Iran
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  • Author Footnotes
    2 Analysis, study design, interpretation of data, article drafting.
    Elnaz Vahidi
    Correspondence
    Corresponding author at: Dept. Emergency Medicine, Tehran University of Medical Sciences, Emergency Medicine Research Center, Shariati Hospital, Tehran, Iran.
    Footnotes
    2 Analysis, study design, interpretation of data, article drafting.
    Affiliations
    Tehran University of Medical Sciences, Shariati Hospital, Emergency Medicine Research Center, Tehran, Iran
    Search for articles by this author
  • Author Footnotes
    3 Data acquisition.
    Javad Seyedhosseini
    Footnotes
    3 Data acquisition.
    Affiliations
    Tehran University of Medical Sciences, Shariati Hospital, Emergency Medicine Research Center, Tehran, Iran
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  • Author Footnotes
    3 Data acquisition.
    Amirhossein Jahanshir
    Footnotes
    3 Data acquisition.
    Affiliations
    Department of Emergency Medicine, School of medicine, Tehran University, Tehran, Iran
    Search for articles by this author
  • Author Footnotes
    1 Study design, supervisor, critical revising.
    2 Analysis, study design, interpretation of data, article drafting.
    3 Data acquisition.
Published:October 20, 2018DOI:https://doi.org/10.1016/j.ajem.2018.10.044

      Abstract

      Background

      Determining prognosis in community acquired pneumonia (CAP), is very important. Many scores are introduced up to now for prediction of pneumonia prognosis like SMART-COP.

      Objective

      To evaluate validity of SMART-COP score in prognosis and severity of CAP in emergency department (ED).

      Methods

      All patients older than 18 years old with clinical suspicion of CAP (meeting the inclusion criteria), were enrolled in our study. In this prospective study, patients were admitted to the ED of a tertiary referral center. Hospital length of stay, rate of intensive care unit (ICU) admission, mortality rate, number of intensive respiratory or vasopressor support (IRVS) use, patients' SMART-COP scores and all demographic data were recorded. Validity of SMART-COP in the prediction of IRVS rate and its correlation with other variables were determined.

      Results

      In this study, 47.6% and 52.4% of patients were females and males respectively. The mean age of patients was 68.13 ± 16.60 years old. The mean hospital length of stay was 13.49 ± 5.62 days. Of all patients entered in our study, 55 cases (38.5%) needed ICU admission, 29 cases (20.3%) were expired within 1 month and 44 cases (30.8%) needed IRVS during their treatment. SMART-COP ≥5 (high risk CAP) accurately predicted the rate of ICU admission, one-month mortality and IRVS need (p-value = 0.001).

      Conclusions

      SMART-COP≥5 had a high sensitivity and specificity in the prediction of patients' prognosis with severe CAP in the ED.

      Keywords

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