respiratory emergency

SCAP Score for Severe Community-Acquired Pneumonia

Severe Community-Acquired Pneumonia (SCAP) score for predicting adverse outcomes (need for ICU, mechanical ventilation, death) in hospitalised CAP patients. 8-variable score. High score predicts severe outcome. Validated by Espana et al. 2006. Can be used alongside PSI/PORT and CURB-65 for ICU triage.

Used in: Pneumonia

Arterial pH below 7.30*

Systolic blood pressure below 90 mmHg*

Respiratory rate above 30/min*

BUN above 30 mg/dL (above 10.7 mmol/L)*

Age above 80 years*

PaO2 below 54 mmHg OR SpO2 below 90% on room air*

Multilobar infiltrates on CXR*

Altered mental status or confusion*

Score interpretation

Low Risk Severe CAP (SCAP 0-9) 0–9

SCAP 0-9 -- low risk of severe outcome (approximately 2%)

→ Ward admission appropriate (confirm with CURB-65/PSI); standard CAP antibiotic treatment (amoxicillin 500 mg-1g TDS PO or IV if unable to tolerate oral, plus clarithromycin 500 mg BD if atypical coverage needed; or co-amoxiclav if aspiration risk); oxygen therapy to maintain SpO2 94-98%; daily clinical and inflammatory marker review; discharge criteria: afebrile, haemodynamically stable, tolerating oral antibiotics; document severity score in notes.

Intermediate Risk (SCAP 10-19) 10–19

SCAP 10-19 -- intermediate severe outcome risk (approximately 10%); consider HDU

→ HDU or closely monitored respiratory ward; IV antibiotics: co-amoxiclav 1.2 g TDS IV plus clarithromycin 500 mg BD IV (or levofloxacin 500 mg OD if penicillin allergy); treat sepsis: fluids, monitoring; serial ABG monitoring; identify pathogen (blood cultures, sputum, pneumococcal UAT, legionella UAT); escalate care if deteriorating; early physiotherapy; VTE prophylaxis; consider respiratory specialist input; repeat CXR at 48-72 hours.

High Risk Severe CAP (SCAP 20 or above) 20–59

SCAP 20 or above -- high risk of ICU admission, MV, or death (approximately 41%)

→ ICU/HDU admission; senior respiratory physician or intensivist involvement; broad-spectrum IV antibiotics: co-amoxiclav or piperacillin-tazobactam plus macrolide (clarithromycin); cover atypicals (legionella, mycoplasma); consider oseltamivir if influenza suspected; aggressive fluid resuscitation and vasopressors if septic shock; consider NIV (CPAP/BiPAP) if hypoxaemic; if NIV failing: intubation and mechanical ventilation (lung-protective ventilation: TV 6 mL/kg predicted BW, PEEP 5-10 cmH2O); proning if severe ARDS (P/F below 150); consider corticosteroids (dexamethasone 6 mg/day) if oxygen-dependent; blood cultures, bronchoscopy/BAL if possible; ECMO consideration if refractory ARDS at ECMO centre.

Interpretation bands for the SCAP Score. Apply clinical judgement and local guidance.

References

Espana PP et al. Development and validation of a clinical prediction rule for severe community-acquired pneumonia. Am J Respir Crit Care Med. 2006;174(11):1249-1256.
Lim WS et al. BTS guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax. 2009;64(Suppl 3):iii1-55.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Drugs

Pathways

Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.

Score interpretation

References

Related