Original Research

Is SMaRTCOP really smart? Validity of SMaRTCOP in the Severity & Prognosis of Community Acquired Pneumonia in the Emergency Department

Sobia Ambreen
Department of Emergency Medicine, King Edward Medical University/ Mayo Hospital
Yar Muhammad
Department of Emergency Medicine, King Edward Medical University/ Mayo Hospital
Muhammad Akif Ali Khan
Department of Emergency Medicine, King Edward Medical University/ Mayo Hospital
Suhail Niaz Khan Niazi
Department of Emergency Medicine, King Edward Medical University/ Mayo Hospital
Muhammad Naeem Safdar
Department of Emergency Medicine, King Edward Medical University/ Mayo Hospital
Hafiz Muhammad Sajid Jehangir
Department of Emergency Medicine, King Edward Medical University/ Mayo Hospital

✉ Correspondence: Sobia Ambreen Email: sobia.ambreen683@gmail.com

DOI https://doi.org/10.70302/jpsim.v6i4.2565
Volume: 6, Issue 4 Pages: 354–358 Published: 21 Nov 2025
Received: 18 Dec 2024 Revised: 25 Feb 2025 Accepted: 11 Oct 2025 Published Online: 21 Nov 2025

Abstract

Objective

To evaluate the validity of the SMaRT-COP score, excluding the indigenous serum albumin levels, in the prognosis and severity of community-acquired pneumonia (CAP) in the emergency department (ED).

Methods

A prospective observational study of patients presenting with clinical signs and symptoms of pneumonia to ED of a tertiary care hospital. Without taking into consideration the albumin levels of the admitting patients with community acquired pneumonia, the sensitivity and specificity of the modified SMaRTCOP score for intensive respiratory & vasopressor support (IRVS) requirements and ICU admissions were determined.

Results

In this study, 55.6% and 44.4% of patients were males and females respectively. The mean age of patients was 53.49±15.84 years old. Among the participants, 41.6% required ICU care, and 70.2% received IRVS as part of their treatment. The SMaRTCOP score of 5 or higher demonstrated a sensitivity of 95.12% and a specificity of 85.45% for predicting the need for IRVS, while, for predicting ICU admission, the sensitivity and specificity were 51.22% and 98.18% respectively, with a p-value of 0.001.

Conclusion

Even without using the indigenous serum albumin levels, we can accurately predict the severity and prognosis of community-acquired pneumonia (CAP) using the SMaRTCOP score in the Emergency Department.

Keywords
Community-acquired pneumonia Prognosis Emergency Department

How to Cite This Article

Ambreen S, Muhammad Y, Khan MAA, Niazi SNK, Safdar MN, Jehangir HMS. Is SMaRTCOP really smart? Validity of SMaRTCOP in the Severity & Prognosis of Community Acquired Pneumonia in the Emergency Department. J Pak Soc Intern Med. 2025;6(4):354–358. doi:10.70302/jpsim.v6i4.2565

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Conflict of Interest

All authors declare no competing interests.

Disclosed in accordance with ICMJE and COPE guidelines.

Funding

No specific funding was received for this research.

Funder information follows the Crossref Funder Registry standard.

References

  1. Walls R, Hockberger R, Gausche-Hill M, Erickson TB, Wilcox SR. Rosen's Emergency Medicine-Concepts and Clinical Practice E-Book: 2-Volume Set. Elsevier Health Sciences; 2022; pp. 871–880
  2. Anderson E, French S, Maloney GE. Community-Acquired Pneumonia, Aspiration Pneumonia, and Noninfectious Pulmonary Infiltrates. Tintinalli’s emergency medicine: A comprehensive study guide. New York: McGraw-Hill Education, 2020, pp 439- 49.
  3. Wunderink RG, Waterer GW. Community-acquired pneumonia. N Engl J Med. 2014 Feb 6;370(6):543-51.
  4. Lim WS. Community acquired pneumonia. J Clin Med. 2004;4(3):224-8.
  5. Myint PK, Kwok CS, Majumdar SR, Eurich DT, Clark AB, Espana PP, et al. The International Community-Acquired Pneumonia (CAP) Collaboration Cohort (ICCC) study: rationale, design, and description of study cohorts and patients. BMJ. 2012;2(3):e001030.
  6. Musher DM, Thorner AR. Community-Acquired Pneumonia. N Engl J Med. 2014;371(17):1619–28.
  7. Capelastegui A, Espana PP, Quintana JM, Areitio I, Gorordo I, Egurrola M. Validation of a predictive rule for the management of community-acquired pneumonia. Eur Respir J. 2006;27(1):151-7.
  8. Niederman MS. Making sense of scoring systems in community-acquired pneumonia. Respirology. 2009;14(3):327–35.
  9. Shindo Y, Sato S, Maruyama E, Ohashi T, Ogawa M, Imaizumi K, et al. Comparison of severity scoring systems A-DROP and CURB-65 for community-acquired pneumonia. Respirol. 2008; 13(5):731–5.
  10. Fukuyama H, Ishida T, Tachibana H, Nakagawa H, Iwasaku M, Saigusa M, et al. Validation of Scoring Systems for Predicting Severe Community-Acquired Pneumonia. Intern Med. 2011; 50(18):1917–22.
  11. Robins-Browne KL, Cheng AC, Thomas KAS, Palmer DJ, Currie BJ, Davis JS. The SMART-COP score performs well for pneumonia risk stratification in Australia’s Tropical Northern Territory: a prospective cohort study. Trop Med Int Health. 2012;17(7):914–9.
  12. Memon RA, Rashid MA, Avva S, Chunchu VA, Ijaz H, Ganaie ZA, et al. The Use of the SMART-COP Score in Predicting Severity Outcomes Among Patients With Community-Acquired Pneumonia: A Meta-Analysis. Cureus. 2022;14(7):e27248.
  13. Ehsanpoor B, Vahidi E, Seyedhosseini J, Jahanshir A. Validity of SMART-COP score in prognosis and severity of community acquired pneumonia in the emergency department. Am J Emerg Med. 2018; 37(8):1450-4.
  14. Bauer TT, Ewig S, Marre R, Suttorp N, Welte T. CRB-65 predicts death from community-acquired pneumonia. J Intern Med. 2006; 260(1):93– 101.
  15. Davis JS, Cross GB, Charles PGP, Currie BJ, Anstey NM, Cheng AC. Pneumonia risk stratification in tropical Australia: does the SMART‐COP score apply? Med J Aust. 2010 Feb; 192(3):133–6.
  16. Arifin WN. A Web-based Sample Size Calculator for Reliability Studies. Edu Med J. 2018;10(3):67-76.
  17. Charles Patrick G P, Wolfe R, Whitby M, Fine Michael J, Fuller Andrew J, Stirling R, 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):375–84.
  18. Marti C, Garin N, Grosgurin O, Poncet A, Combescure C, Carballo S. Prediction of severe community-acquired pneumonia: a systematic review and meta-analysis. Crit Care. 2012;16(4):R141.

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CC BY CC BY 4.0 This article is published under the Creative Commons Attribution 4.0 International License. May be shared and adapted with attribution. © 2025 Journal of Pakistan Society of Internal Medicine.
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