Severe Community-Acquired Pneumonia (SCAP) Score

SCAP Score Calculator

Arterial pH (13 points if <7.30)

Systolic Blood Pressure (11 points if <90)

mmHg

Multilobar/bilateral CXR involvement

PaO₂/FiO₂ < 250

BUN > 30 mg/dL

Altered mental status / Confusion

Age ≥80 years

Respiratory rate ≥30/min

Heart rate ≥125/min

SCAP Score: 0

Non-Severe CAP

SCAP Score: 0 (<10). Non-severe community-acquired pneumonia. May be managed with standard care. Monitor for clinical deterioration.

Predicts risk of adverse outcomes in CAP patients in the ED.

Why Use

Assists with disposition decision after diagnosing CAP in the ED.

When to Use

In the ED, after diagnosis of community-acquired pneumonia is made, calculating SCAP may help predict the chance for "severe CAP", defined by adverse outcomes including inpatient mortality, septic shock, and/or need for mechanical ventilation.

Formula

Addition of the selected points: Variable Points Arterial pH <7.30 Yes 13 No 0 Systolic pressure <90 mmHg Yes 11 No 0 Respiratory rate >30 breaths/min Yes 9 No 0 BUN >30 mg/dL (>10.7 mmol/L) Yes 5 No 0 Altered mental status (e.g. confusion) Yes 5 No 0 PaO 2 <54 mmHg (or PaO 2 /FiO 2 <250 mmHg) Yes 6 No 0 Age ≥80 years Yes 5 No 0 Multilobar/bilateral X-ray Yes 5 No 0

Pearls / Pitfalls

High risk SCAP showed higher rates of adverse outcomes than high risk PSI and CURB-65 , potentially helping choose which patients are at most need for the ICU with higher specificity ( Yandiola 2009 ). All validations were done in the same Spanish hospital network, by researchers from the same hospital, so may not be generalizable and there is still room for robust external validation. If applying to a patient with potential COVID-19, keep in mind that age has a much stronger odds ratio for increasing mortality risk in COVID-19 patients than with other viral PNA patients.

Critical Actions

If applying to a patient with potential COVID-19, use this score in conjunction with clinical suspicion and risk factors — particularly advanced age and comorbidities.

Advice

Threshold for disposition may change during resource-limited situations (such as the COVID-19 outbreak).

More Information

SCAP Score* Risk of SCAP** 0 0.27-3.43% 1-9 0.66-3.25% 10-19 9.23-11.24% 20-29 36.62-41.82% ≥30 50% *Patients with scores ≥10 are classified as having severe community-acquired pneumonia and are recommended for ICU, monitored bed, and/or immediate intervention. **Defined as in-hospital death, septic shock, and/or need for mechanical ventilation.