SMART‐COP: A Tool for Predicting the Need for Intensive Respiratory or Vasopressor Support in Community‐Acquired Pneumonia

Charles, Patrick G P; Wolfe, Rory; Whitby, Michael; Fine, Michael J.; Fuller, Andrew; Stirling, Robert; Wright, A. A.; Ramirez, Julio A.; Christiansen, Keryn; Waterer, Grant; Pierce, Robert J; Armstrong, John G.; Korman, Tony M.; Holmes, Peter; Obrosky, Scott D; Peyrani, Paula; Johnson, Barbara; Hooy, Michelle; Grayson, M. L.

doi:10.1086/589754

Cited by 452 publications

(408 citation statements)

References 28 publications

Supporting

Mentioning

368

Contrasting

Unclassified

Order By: Relevance

“…The values for the 30-day mortality and the need for IRVS in our study were high compared with other studies but seem closer to the values from studies using scoring systems (13,(15)(16)(17)(18). This result may be attributed to the use of inclusion criteria.…”

Section: Discussionsupporting

confidence: 82%

“…The SMART-COP system is reported to work well for patients who were directly hospitalized into the ICU and for those who were transferred from the general wards (13). In a recent study, PSI was found to be successful in (13). Although the SMART-COP system was specifically designed to predict the need for IRVS, we did not observe this difference in our study, possibly because of the relatively low number of cases.…”

Section: Pointcontrasting

confidence: 62%

Section: Pointmentioning

confidence: 99%

See 2 more Smart Citations

Comparison of Severity Scoring Systems in Community-Acquired Pneumonia

Alıcı¹,

Çapan²,

Ertürk³

et al. 2015

Eurasian J Pulmonol

View full text Add to dashboard Cite

Section: Discussionsupporting

confidence: 82%

Section: Pointcontrasting

confidence: 62%

See 1 more Smart Citation

Comparison of Severity Scoring Systems in Community-Acquired Pneumonia

Alıcı¹,

Çapan²,

Ertürk³

et al. 2015

Eurasian J Pulmonol

View full text Add to dashboard Cite

“…En la admisión al hospital se consignaron las características sociodemográficas, comorbilidades, cuadro clínico, signos vitales y exámenes de laboratorio medidos en el servicio de urgencia que permitieron calcular los cuatro índices pronósti-cos examinados: PSI, CURB-65, SMART-COP y SCAP [18][19][20][21] . Además, se calculó la variante CRB-65, que a diferencia del CURB-65, no requiere exámenes de laboratorio y puede ser utilizada por los médicos en el ámbito ambulatorio 23 .…”

Section: Pacientes Y Métodounclassified

“…El índice de gravedad descrito por Charles y cols. (SMART-COP) permite identificar al paciente con NAC grave, predice la necesidad de apoyo hemodinámico y uso de ventilación mecánica, define la categoría de riesgo elevado por un puntaje mayor o igual a seis 20 . El índice de neumonía comunitaria grave (SCAP) descrito por España y cols.…”

Section: Pacientes Y Métodounclassified

Evaluación de los índices predictores de eventos adversos en el adulto inmunocompetente hospitalizado por neumonía adquirida en la comunidad

et al. 2017

View full text Add to dashboard Cite

Effectiveness of a Bundled Intervention Including Adjunctive Corticosteroids on Outcomes of Hospitalized Patients With Community-Acquired Pneumonia

et al. 2019

View full text Add to dashboard Cite

for the Improving Evidence-Based Treatment Gaps and Outcomes in Community-Acquired Pneumonia (IMPROVE-GAP) Implementation Team at Western Health IMPORTANCE Community-acquired pneumonia remains a leading cause of hospitalization, mortality, and health care costs worldwide. Randomized clinical trials support the use of adjunctive corticosteroids, early progressive mobilization, antibiotic switching rules, and dietary interventions in improving outcomes. However, it is uncertain whether implementing these interventions will translate into effectiveness under routine health care conditions. OBJECTIVE To evaluate the effectiveness of a bundle of evidence-supported treatments under conditions of routine care in a representative population hospitalized for community-acquired pneumonia. DESIGN, SETTING, AND PARTICIPANTSA double-blind, stepped-wedge, cluster-randomized clinical trial with 90-day follow-up was conducted between August 1, 2016, and October 29, 2017, in the general internal medicine service at 2 tertiary hospitals in Melbourne, Australia, among a consecutive sample of patients with community-acquired pneumonia. The primary analysis and preparation of results took place between May 14 and November 25, 2018.INTERVENTIONS Treating clinical teams were advised to prescribe prednisolone acetate, 50 mg/d, for 7 days (in the absence of any contraindication) and de-escalate from parenteral to oral antibiotics according to standardized criteria. Algorithm-guided early mobilization and malnutrition screening and treatment were also implemented. MAIN OUTCOMES AND MEASURESHospital length of stay, mortality, readmission, and intervention-associated adverse events (eg, gastrointestinal bleeding and hyperglycemia).RESULTS A total of 917 patients were screened, and 816 (351 women and 465 men; mean [SD] age, 76 [13] years) were included in the intention-to-treat analysis, with 401 patients receiving the intervention and 415 patients in the control group. An unadjusted geometric mean ratio of 0.95 (95% CI, 0.78-1.16) was observed for the difference in length of stay (days) between the intervention and control groups. Similarly, no significant differences were observed for the secondary outcomes of mortality and readmission, and the results remained unchanged after further adjustment for sex and age. The study reported higher proportions of gastrointestinal bleeding in the intervention group (9 [2.2%]) compared with the controls (3 [0.7%]), with an unadjusted estimated difference in mean proportions of 0.008 (95% CI, 0.005-0.010). CONCLUSIONS AND RELEVANCEThis bundled intervention including adjunctive corticosteroids demonstrated no evidence of effectiveness and resulted in a higher incidence of gastrointestinal bleeding. Efficacy of individual interventions demonstrated in clinical trials may not necessarily translate into effectiveness when implemented in combination and may even result in net harm.TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02835040

show abstract

SMART‐COP: A Tool for Predicting the Need for Intensive Respiratory or Vasopressor Support in Community‐Acquired Pneumonia

Abstract: SMART-COP is a simple, practical clinical tool for accurately predicting the need for IRVS that is likely to assist clinicians in determining CAP severity.

Cited by 452 publications

References 28 publications

Comparison of Severity Scoring Systems in Community-Acquired Pneumonia

Comparison of Severity Scoring Systems in Community-Acquired Pneumonia

Evaluación de los índices predictores de eventos adversos en el adulto inmunocompetente hospitalizado por neumonía adquirida en la comunidad

Effectiveness of a Bundled Intervention Including Adjunctive Corticosteroids on Outcomes of Hospitalized Patients With Community-Acquired Pneumonia

Contact Info

Product

Resources

About