SMART-COP: A Tool for Predicting the Need for Intensive Respiratory or Vasopressor Support in Community-Acquired Pneumonia
Background. Existing severity assessment tools, such as the pneumonia severity index (PSI) and CURB-65 (tool based on confusion, urea level, respiratory rate, blood pressure, and age
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Veröffentlicht in: | Clinical infectious diseases 2008-08, Vol.47 (3), p.375-384 |
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creator | Charles, Patrick G. P. Wolfe, Rory Whitby, Michael Fine, Michael J. Fuller, Andrew J. Stirling, Robert Wright, Alistair A. Ramirez, Julio A. Christiansen, Keryn J. Waterer, Grant W. Pierce, Robert J. Armstrong, John G. Korman, Tony M. Holmes, Peter Obrosky, D. Scott Peyrani, Paula Johnson, Barbara Hooy, Michelle Grayson, M. Lindsay |
description | Background. Existing severity assessment tools, such as the pneumonia severity index (PSI) and CURB-65 (tool based on confusion, urea level, respiratory rate, blood pressure, and age |
doi_str_mv | 10.1086/589754 |
format | Article |
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P. ; Wolfe, Rory ; Whitby, Michael ; Fine, Michael J. ; Fuller, Andrew J. ; Stirling, Robert ; Wright, Alistair A. ; Ramirez, Julio A. ; Christiansen, Keryn J. ; Waterer, Grant W. ; Pierce, Robert J. ; Armstrong, John G. ; Korman, Tony M. ; Holmes, Peter ; Obrosky, D. Scott ; Peyrani, Paula ; Johnson, Barbara ; Hooy, Michelle ; Grayson, M. Lindsay</creator><creatorcontrib>Charles, Patrick G. P. ; Wolfe, Rory ; Whitby, Michael ; Fine, Michael J. ; Fuller, Andrew J. ; Stirling, Robert ; Wright, Alistair A. ; Ramirez, Julio A. ; Christiansen, Keryn J. ; Waterer, Grant W. ; Pierce, Robert J. ; Armstrong, John G. ; Korman, Tony M. ; Holmes, Peter ; Obrosky, D. Scott ; Peyrani, Paula ; Johnson, Barbara ; Hooy, Michelle ; Grayson, M. Lindsay ; Australian Community-Acquired Pneumonia Study Collaboration ; Australian Community-Acquired Pneumonia Study Collaboration ; Australian Community‐Acquired Pneumonia Study Collaboration</creatorcontrib><description>Background. Existing severity assessment tools, such as the pneumonia severity index (PSI) and CURB-65 (tool based on confusion, urea level, respiratory rate, blood pressure, and age <65 years), predict 30-day mortality in community-acquired pneumonia (CAP) and have limited ability to predict which patients will require intensive respiratory or vasopressor support (IRVS). Methods. The Australian CAP Study (ACAPS) was a prospective study of 882 episodes in which each patient had a detailed assessment of severity features, etiology, and treatment outcomes. Multivariate logistic regression was performed to identify features at initial assessment that were associated with receipt of IRVS. These results were converted into a simple points-based severity tool that was validated in 5 external databases, totaling 7464 patients. Results. In ACAPS, 10.3% of patients received IRVS, and the 30-day mortality rate was 5.7%. The features statistically significantly associated with receipt of IRVS were low systolic blood pressure (2 points), multilobar chest radiography involvement (1 point), low albumin level (1 point), high respiratory rate (1 point), tachycardia (1 point), confusion (1 point), poor oxygenation (2 points), and low arterial pH (2 points): SMART-COP. A SMART-COP score of <3 points identified 92% of patients who received IRVS, including 84% of patients who did not need immediate admission to the intensive care unit. Accuracy was also high in the 5 validation databases. Sensitivities of PSI and CURB-65 for identifying the need for IRVS were 74% and 39%, respectively. Conclusions. 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.</description><identifier>ISSN: 1058-4838</identifier><identifier>EISSN: 1537-6591</identifier><identifier>DOI: 10.1086/589754</identifier><identifier>PMID: 18558884</identifier><identifier>CODEN: CIDIEL</identifier><language>eng</language><publisher>Chicago, IL: The University of Chicago Press</publisher><subject>Aged ; Articles and Commentaries ; Biological and medical sciences ; Blood pressure ; Community-Acquired Infections - diagnosis ; Diagnostic tests ; Female ; Hospital admissions ; Humans ; Hypoxia ; Infectious diseases ; Intensive care units ; Male ; Medical sciences ; Middle Aged ; Mortality ; Pneumology ; Pneumonia ; Pneumonia - diagnosis ; Radiography ; Respiratory rate ; Respiratory system : syndromes and miscellaneous diseases ; ROC Curve ; Severity of Illness Index ; Studies ; Tachycardia</subject><ispartof>Clinical infectious diseases, 2008-08, Vol.47 (3), p.375-384</ispartof><rights>Copyright 2008 Infectious Diseases Society of America</rights><rights>2008 by the Infectious Diseases Society of America 2008</rights><rights>2008 INIST-CNRS</rights><rights>Copyright University of Chicago, acting through its Press Aug 1, 2008</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c549t-a362a252b9f7b278edafa861c648cadfa8dfbce7f0fdea0e0bf13dd7b96f1d923</citedby><cites>FETCH-LOGICAL-c549t-a362a252b9f7b278edafa861c648cadfa8dfbce7f0fdea0e0bf13dd7b96f1d923</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.jstor.org/stable/pdf/40307651$$EPDF$$P50$$Gjstor$$H</linktopdf><linktohtml>$$Uhttps://www.jstor.org/stable/40307651$$EHTML$$P50$$Gjstor$$H</linktohtml><link.rule.ids>314,776,780,799,27901,27902,57992,58225</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=20516838$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18558884$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Charles, Patrick G. P.</creatorcontrib><creatorcontrib>Wolfe, Rory</creatorcontrib><creatorcontrib>Whitby, Michael</creatorcontrib><creatorcontrib>Fine, Michael J.</creatorcontrib><creatorcontrib>Fuller, Andrew J.</creatorcontrib><creatorcontrib>Stirling, Robert</creatorcontrib><creatorcontrib>Wright, Alistair A.</creatorcontrib><creatorcontrib>Ramirez, Julio A.</creatorcontrib><creatorcontrib>Christiansen, Keryn J.</creatorcontrib><creatorcontrib>Waterer, Grant W.</creatorcontrib><creatorcontrib>Pierce, Robert J.</creatorcontrib><creatorcontrib>Armstrong, John G.</creatorcontrib><creatorcontrib>Korman, Tony M.</creatorcontrib><creatorcontrib>Holmes, Peter</creatorcontrib><creatorcontrib>Obrosky, D. Scott</creatorcontrib><creatorcontrib>Peyrani, Paula</creatorcontrib><creatorcontrib>Johnson, Barbara</creatorcontrib><creatorcontrib>Hooy, Michelle</creatorcontrib><creatorcontrib>Grayson, M. Lindsay</creatorcontrib><creatorcontrib>Australian Community-Acquired Pneumonia Study Collaboration</creatorcontrib><creatorcontrib>Australian Community-Acquired Pneumonia Study Collaboration</creatorcontrib><creatorcontrib>Australian Community‐Acquired Pneumonia Study Collaboration</creatorcontrib><title>SMART-COP: A Tool for Predicting the Need for Intensive Respiratory or Vasopressor Support in Community-Acquired Pneumonia</title><title>Clinical infectious diseases</title><addtitle>Clinical Infectious Diseases</addtitle><addtitle>Clinical Infectious Diseases</addtitle><description>Background. Existing severity assessment tools, such as the pneumonia severity index (PSI) and CURB-65 (tool based on confusion, urea level, respiratory rate, blood pressure, and age <65 years), predict 30-day mortality in community-acquired pneumonia (CAP) and have limited ability to predict which patients will require intensive respiratory or vasopressor support (IRVS). Methods. The Australian CAP Study (ACAPS) was a prospective study of 882 episodes in which each patient had a detailed assessment of severity features, etiology, and treatment outcomes. Multivariate logistic regression was performed to identify features at initial assessment that were associated with receipt of IRVS. These results were converted into a simple points-based severity tool that was validated in 5 external databases, totaling 7464 patients. Results. In ACAPS, 10.3% of patients received IRVS, and the 30-day mortality rate was 5.7%. The features statistically significantly associated with receipt of IRVS were low systolic blood pressure (2 points), multilobar chest radiography involvement (1 point), low albumin level (1 point), high respiratory rate (1 point), tachycardia (1 point), confusion (1 point), poor oxygenation (2 points), and low arterial pH (2 points): SMART-COP. A SMART-COP score of <3 points identified 92% of patients who received IRVS, including 84% of patients who did not need immediate admission to the intensive care unit. Accuracy was also high in the 5 validation databases. Sensitivities of PSI and CURB-65 for identifying the need for IRVS were 74% and 39%, respectively. Conclusions. 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.</description><subject>Aged</subject><subject>Articles and Commentaries</subject><subject>Biological and medical sciences</subject><subject>Blood pressure</subject><subject>Community-Acquired Infections - diagnosis</subject><subject>Diagnostic tests</subject><subject>Female</subject><subject>Hospital admissions</subject><subject>Humans</subject><subject>Hypoxia</subject><subject>Infectious diseases</subject><subject>Intensive care units</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Pneumology</subject><subject>Pneumonia</subject><subject>Pneumonia - diagnosis</subject><subject>Radiography</subject><subject>Respiratory rate</subject><subject>Respiratory system : syndromes and miscellaneous diseases</subject><subject>ROC Curve</subject><subject>Severity of Illness Index</subject><subject>Studies</subject><subject>Tachycardia</subject><issn>1058-4838</issn><issn>1537-6591</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqF0V1rFDEUBuBBFPuh_gMlCno3mkwmmcS7Zau2Wu3SrlK8CZl82KwzyTSZEddfb-ouWxDEqxxyHt4Q3qJ4hOBLBBl9RRhvSH2n2EcENyUlHN3NMySsrBlme8VBSisIEWKQ3C_2ECOEMVbvF78uPs7Ol-X8bPEazMAyhA7YEMEiGu3U6Pw3MF4Z8MkY_ef-xI_GJ_fDgHOTBhflGOIa5MUXmcIQTUp5vpiGIcQROA_moe8n78Z1OVPXk8upYOHN1Afv5IPinpVdMg-352Hx-e2b5fy4PD17dzKfnZaK1HwsJaaVrEjVctu0VcOMllYyihStmZI6z9q2yjQWWm0kNLC1CGvdtJxapHmFD4sXm9whhuvJpFH0LinTddKbMCVBOYYVpPV_YYUwb3iNMnz2F1yFKfr8iWw4JxQycpumYkgpGiuG6HoZ1wJBcdOZ2HSW4ZNt2tT2Rt-ybUkZPN8CmZTsbJReubRzFSSI5pKze7pxYRr-_djjjVmlXN1O1RDDhpKbr5WbvUuj-bnby_hd0AY3RBxffhVH9AN6X10uBMe_ASzowXM</recordid><startdate>20080801</startdate><enddate>20080801</enddate><creator>Charles, Patrick G. P.</creator><creator>Wolfe, Rory</creator><creator>Whitby, Michael</creator><creator>Fine, Michael J.</creator><creator>Fuller, Andrew J.</creator><creator>Stirling, Robert</creator><creator>Wright, Alistair A.</creator><creator>Ramirez, Julio A.</creator><creator>Christiansen, Keryn J.</creator><creator>Waterer, Grant W.</creator><creator>Pierce, Robert J.</creator><creator>Armstrong, John G.</creator><creator>Korman, Tony M.</creator><creator>Holmes, Peter</creator><creator>Obrosky, D. Scott</creator><creator>Peyrani, Paula</creator><creator>Johnson, Barbara</creator><creator>Hooy, Michelle</creator><creator>Grayson, M. Lindsay</creator><general>The University of Chicago Press</general><general>University of Chicago Press</general><general>Oxford University Press</general><scope>BSCLL</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7T2</scope><scope>7T7</scope><scope>7U7</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>P64</scope><scope>7X8</scope></search><sort><creationdate>20080801</creationdate><title>SMART-COP: A Tool for Predicting the Need for Intensive Respiratory or Vasopressor Support in Community-Acquired Pneumonia</title><author>Charles, Patrick G. P. ; Wolfe, Rory ; Whitby, Michael ; Fine, Michael J. ; Fuller, Andrew J. ; Stirling, Robert ; Wright, Alistair A. ; Ramirez, Julio A. ; Christiansen, Keryn J. ; Waterer, Grant W. ; Pierce, Robert J. ; Armstrong, John G. ; Korman, Tony M. ; Holmes, Peter ; Obrosky, D. Scott ; Peyrani, Paula ; Johnson, Barbara ; Hooy, Michelle ; Grayson, M. Lindsay</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c549t-a362a252b9f7b278edafa861c648cadfa8dfbce7f0fdea0e0bf13dd7b96f1d923</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Aged</topic><topic>Articles and Commentaries</topic><topic>Biological and medical sciences</topic><topic>Blood pressure</topic><topic>Community-Acquired Infections - diagnosis</topic><topic>Diagnostic tests</topic><topic>Female</topic><topic>Hospital admissions</topic><topic>Humans</topic><topic>Hypoxia</topic><topic>Infectious diseases</topic><topic>Intensive care units</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Pneumology</topic><topic>Pneumonia</topic><topic>Pneumonia - diagnosis</topic><topic>Radiography</topic><topic>Respiratory rate</topic><topic>Respiratory system : syndromes and miscellaneous diseases</topic><topic>ROC Curve</topic><topic>Severity of Illness Index</topic><topic>Studies</topic><topic>Tachycardia</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Charles, Patrick G. P.</creatorcontrib><creatorcontrib>Wolfe, Rory</creatorcontrib><creatorcontrib>Whitby, Michael</creatorcontrib><creatorcontrib>Fine, Michael J.</creatorcontrib><creatorcontrib>Fuller, Andrew J.</creatorcontrib><creatorcontrib>Stirling, Robert</creatorcontrib><creatorcontrib>Wright, Alistair A.</creatorcontrib><creatorcontrib>Ramirez, Julio A.</creatorcontrib><creatorcontrib>Christiansen, Keryn J.</creatorcontrib><creatorcontrib>Waterer, Grant W.</creatorcontrib><creatorcontrib>Pierce, Robert J.</creatorcontrib><creatorcontrib>Armstrong, John G.</creatorcontrib><creatorcontrib>Korman, Tony M.</creatorcontrib><creatorcontrib>Holmes, Peter</creatorcontrib><creatorcontrib>Obrosky, D. Scott</creatorcontrib><creatorcontrib>Peyrani, Paula</creatorcontrib><creatorcontrib>Johnson, Barbara</creatorcontrib><creatorcontrib>Hooy, Michelle</creatorcontrib><creatorcontrib>Grayson, M. Lindsay</creatorcontrib><creatorcontrib>Australian Community-Acquired Pneumonia Study Collaboration</creatorcontrib><creatorcontrib>Australian Community-Acquired Pneumonia Study Collaboration</creatorcontrib><creatorcontrib>Australian Community‐Acquired Pneumonia Study Collaboration</creatorcontrib><collection>Istex</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical infectious diseases</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Charles, Patrick G. P.</au><au>Wolfe, Rory</au><au>Whitby, Michael</au><au>Fine, Michael J.</au><au>Fuller, Andrew J.</au><au>Stirling, Robert</au><au>Wright, Alistair A.</au><au>Ramirez, Julio A.</au><au>Christiansen, Keryn J.</au><au>Waterer, Grant W.</au><au>Pierce, Robert J.</au><au>Armstrong, John G.</au><au>Korman, Tony M.</au><au>Holmes, Peter</au><au>Obrosky, D. Scott</au><au>Peyrani, Paula</au><au>Johnson, Barbara</au><au>Hooy, Michelle</au><au>Grayson, M. Lindsay</au><aucorp>Australian Community-Acquired Pneumonia Study Collaboration</aucorp><aucorp>Australian Community-Acquired Pneumonia Study Collaboration</aucorp><aucorp>Australian Community‐Acquired Pneumonia Study Collaboration</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>SMART-COP: A Tool for Predicting the Need for Intensive Respiratory or Vasopressor Support in Community-Acquired Pneumonia</atitle><jtitle>Clinical infectious diseases</jtitle><stitle>Clinical Infectious Diseases</stitle><addtitle>Clinical Infectious Diseases</addtitle><date>2008-08-01</date><risdate>2008</risdate><volume>47</volume><issue>3</issue><spage>375</spage><epage>384</epage><pages>375-384</pages><issn>1058-4838</issn><eissn>1537-6591</eissn><coden>CIDIEL</coden><abstract>Background. Existing severity assessment tools, such as the pneumonia severity index (PSI) and CURB-65 (tool based on confusion, urea level, respiratory rate, blood pressure, and age <65 years), predict 30-day mortality in community-acquired pneumonia (CAP) and have limited ability to predict which patients will require intensive respiratory or vasopressor support (IRVS). Methods. The Australian CAP Study (ACAPS) was a prospective study of 882 episodes in which each patient had a detailed assessment of severity features, etiology, and treatment outcomes. Multivariate logistic regression was performed to identify features at initial assessment that were associated with receipt of IRVS. These results were converted into a simple points-based severity tool that was validated in 5 external databases, totaling 7464 patients. Results. In ACAPS, 10.3% of patients received IRVS, and the 30-day mortality rate was 5.7%. The features statistically significantly associated with receipt of IRVS were low systolic blood pressure (2 points), multilobar chest radiography involvement (1 point), low albumin level (1 point), high respiratory rate (1 point), tachycardia (1 point), confusion (1 point), poor oxygenation (2 points), and low arterial pH (2 points): SMART-COP. A SMART-COP score of <3 points identified 92% of patients who received IRVS, including 84% of patients who did not need immediate admission to the intensive care unit. Accuracy was also high in the 5 validation databases. Sensitivities of PSI and CURB-65 for identifying the need for IRVS were 74% and 39%, respectively. Conclusions. 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.</abstract><cop>Chicago, IL</cop><pub>The University of Chicago Press</pub><pmid>18558884</pmid><doi>10.1086/589754</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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source | Jstor Complete Legacy; Oxford University Press Journals All Titles (1996-Current); MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
subjects | Aged Articles and Commentaries Biological and medical sciences Blood pressure Community-Acquired Infections - diagnosis Diagnostic tests Female Hospital admissions Humans Hypoxia Infectious diseases Intensive care units Male Medical sciences Middle Aged Mortality Pneumology Pneumonia Pneumonia - diagnosis Radiography Respiratory rate Respiratory system : syndromes and miscellaneous diseases ROC Curve Severity of Illness Index Studies Tachycardia |
title | SMART-COP: A Tool for Predicting the Need for Intensive Respiratory or Vasopressor Support in Community-Acquired Pneumonia |
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