SMART-COP 评分在急诊科社区获得性肺炎预后和严重程度评估中的有效性。

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

机构信息

Tehran University of Medical Sciences, Shariati Hospital, Emergency Medicine Research Center, Tehran, Iran.

出版信息

Am J Emerg Med. 2019 Aug;37(8):1450-1454. doi: 10.1016/j.ajem.2018.10.044. Epub 2018 Oct 21.

DOI:10.1016/j.ajem.2018.10.044

PMID:30401592

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.

摘要

背景

确定社区获得性肺炎（CAP）的预后非常重要。迄今为止，已经引入了许多评分来预测肺炎的预后，如 SMART-COP。

目的

评估 SMART-COP 评分在急诊科（ED）中 CAP 预后和严重程度的有效性。

方法

所有年龄大于 18 岁且临床疑似 CAP（符合纳入标准）的患者均纳入本研究。在这项前瞻性研究中，患者被收入三级转诊中心的 ED。记录患者的住院时间、入住重症监护病房（ICU）的比例、死亡率、需要使用密集呼吸或血管加压支持（IRVS）的次数、SMART-COP 评分和所有人口统计学数据。确定 SMART-COP 在预测 IRVS 率及其与其他变量的相关性方面的有效性。

结果

在这项研究中，分别有 47.6%和 52.4%的患者为女性和男性。患者的平均年龄为 68.13±16.60 岁。平均住院时间为 13.49±5.62 天。在所有纳入本研究的患者中，55 例（38.5%）需要入住 ICU，29 例（20.3%）在 1 个月内死亡，44 例（30.8%）在治疗过程中需要 IRVS。SMART-COP≥5（高危 CAP）准确预测了 ICU 入住率、1 个月死亡率和 IRVS 需求（p 值=0.001）。