SMART COP

SMART-COP: Measures severity of CAP. Specifically designed to predict who will need mechanical ventilation or vasopressors.

Point-of-Care Assessment

Patient Age Threshold

Maintenance Strategy

Low Risk (0)

Minimal risk of requiring intensive respiratory or vasopressor support (IRVS).

Guidelines & Evidence

Clinical Details

Section 1

When to Use

Initial evaluation of Community-Acquired Pneumonia (CAP)

Predicting the requirement for mechanical ventilation or vasopressors

Identifying patients who might need early ICU admission despite low CURB-65 or PORT scores

Section 2

Formula & Logic

The SMART-COP Mnemonic

S: Systolic BP < 90 mmHg (2 pts)

M: Multilobar infiltrates (1 pt)

A: Albumin < 3.5 g/dL (1 pt)

R: Respiratory rate (Age ≤50: ≥25; Age >50: ≥30) (1 pt)

T: Tachycardia ≥ 125 bpm (1 pt)

C: Confusion (1 pt)

O: Oxygenation (Age ≤50: PaO2 <70 or SpO2 ≤93% | Age >50: PaO2 <60 or SpO2 ≤90%) (2 pts)

P: pH < 7.35 (2 pts)

Interpretation

0–2 points	Low Risk
3–4 points	Moderate Risk (1 in 8 require IRVS)
5–6 points	High Risk (1 in 3 require IRVS)
≥ 7 points	Very High Risk (2 in 3 require IRVS)

Section 3

Evidence Appraisal

Validation

SMART-COP: a tool for predicting the need for intensive respiratory or vasopressor support in community-acquired pneumonia.

Charles PG et al. • Clin Infect Dis.. 2008;47(4):482-9. Validated as superior to CURB-65 for predicting IRVS requirement.

Last Comprehensive Review: 2026

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