Pulmonology
SMART-COP (Pneumonia)
Predicts need for intensive respiratory/vasopressor support.
Education and reference only. Not a substitute for clinical judgement, local policy or product labelling. Always verify before clinical use. Values are calculated in your browser and never stored.
Background
SMART-COP predicts the need for intensive respiratory or vasopressor support (IRVS) in adults with community-acquired pneumonia (CAP), helping to identify those who may deteriorate and need critical care. The acronym covers Systolic blood pressure, Multilobar infiltrates, Albumin, Respiratory rate, Tachycardia, Confusion, Oxygenation and arterial pH. Each component scores 1 or 2 points, with low systolic blood pressure, low oxygenation and low pH weighted at 2 points each. It was designed to complement mortality-focused tools such as CURB-65 by predicting the need for organ support rather than death.
Interpreting the result
A score of 0–2 indicates a low risk of needing intensive respiratory or vasopressor support. A score of 3–4 represents moderate risk (around one in eight). A score of 5 or more indicates high risk and should prompt consideration of intensive-care assessment. Because the oxygenation criterion is age-adjusted, the same oxygen value may or may not score depending on the patient's age.
Advice
Oxygen criterion is age-adjusted: ≤50y PaO₂<70 / SpO₂≤93 / PF<333; >50y PaO₂<60 / SpO₂≤90 / PF<250. Use alongside CURB-65 and clinical judgement.
Worked example
A 55-year-old with systolic BP 85 mmHg (2), respiratory rate 32/min (1) and new confusion (1) scores 4. This is the moderate-risk group, signalling a meaningful chance of needing intensive respiratory or vasopressor support and warranting close monitoring.
Pearls / pitfalls
- The oxygenation criterion is age-adjusted (≤50y: PaO₂<70 / SpO₂≤93 / PF<333; >50y: PaO₂<60 / SpO₂≤90 / PF<250), so apply the correct age band.
- It predicts the need for organ support, not mortality — use it alongside CURB-65 rather than instead of it.
- Several inputs (albumin, arterial pH, chest film) require investigations, so the full score may not be available at first contact.
- As with all severity scores, clinical judgement and the patient's trajectory override the number.
Evidence & validation
SMART-COP was derived and validated by Charles et al. across the Australian Community-Acquired Pneumonia Study and other cohorts, and is used internationally alongside CURB-65 to support disposition decisions in CAP.
Frequently asked questions
What does SMART-COP predict?
It predicts the need for intensive respiratory or vasopressor support in community-acquired pneumonia — essentially the likelihood of needing organ support and intensive care, rather than the risk of death.
How does SMART-COP differ from CURB-65?
CURB-65 predicts 30-day mortality, whereas SMART-COP predicts the need for intensive respiratory or vasopressor support. They are complementary, and SMART-COP can flag patients who need critical care even when mortality scores look reassuring.
What score should prompt intensive-care assessment?
A score of 5 or more indicates high risk of needing intensive respiratory or vasopressor support and should prompt consideration of intensive-care review. Scores of 3–4 are moderate risk warranting close monitoring.
Why is the oxygen criterion age-adjusted?
Normal oxygen levels decline with age, so SMART-COP uses stricter thresholds in patients aged 50 or under and more lenient ones in those over 50, to avoid over- or under-scoring oxygenation.
References
- Charles PGP, Wolfe R, Whitby M, et al. SMART-COP: a tool for predicting the need for intensive respiratory or vasopressor support in community-acquired pneumonia. Clin Infect Dis. 2008;47(3):375–384.
- British Thoracic Society. Guidelines for the management of community acquired pneumonia in adults.
About the creator
Charles PG et al.
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