🧭 REBEL Rundown
🗝️ Key Points
- 🧮 Different scores, different questions: CURB-65 and PSI/PORT are built for mortality risk & disposition, while SMART-COP is aimed at who will need IRVS/ICU.
- ⚡ CURB-65: Fast, familiar, great for quick admit vs discharge—but can miss younger high-risk or ICU-bound patients.
- 📊 PSI/PORT: Data-heavy, very good for 30-day mortality and site-of-care, but can underestimate severity in younger, otherwise healthy patients and takes more work.
- 🚨 SMART-COP: Picks up patients likely to need respiratory support or pressors, often catching “low-risk” by CURB-65/PSI who are actually on the brink of crashing.
- 🧠 None are perfect: None include procalcitonin, frailty, functional status, or gestalt, so scores should guide, not replace, clinical judgment.
🤕 Case
Earl, proudly hosting his 75th birthday party, blew out the candles with such force (and cough) that half the frosting—and likely half the room—were coated in suspicious aerosols. Two days later, he arrived in the ED febrile and confused, with a respiratory rate of 32, SpO₂ 88% on room air, and systolic BP hovering around 90 mmHg. Chest X-ray showed multilobar infiltrates, and his heart rate was 115, raising concern for significant pneumonia severity. His family thought it was just “birthday excitement,” but your clinical decision tools think otherwise…
📌 Background:
Pneumonia season doesn’t just fill your waiting room – it fills your brain with decisions: Admit or discharge? Floor or ICU? CURB-65, PSI/PORT, and SMART-COP all promise to help, but they’re not built to answer the same question. This quick comparison walks you through how each score thinks, where each one shines, and when a “low-risk” patient might actually be one bad hour away from crashing.
Don’t just diagnose pneumonia — predict who might acutely decompensate.
🔗 Scoring Tools:
🎯 Quick Hits
💬 Case Resolution
Earl’s week started with cake and candles but progressed to crackles and confusion. CURB-65 suggested he stay in the hospital, PSI/PORT reminded us that 75-year-olds with confusion and multilobar pneumonia cannot be discharged with a goodie bag, and SMART-COP waved an ICU flag. Thanks to early recognition and escalation, he recovered quickly (and now coughs away from desserts!),
🚨 Clinical Bottom Line
- CURB-65: Fast, familiar, and great for admission decisions — but its simplicity can overlook some high-risk, ICU-bound patients.
- PSI/PORT: In-depth and data-heavy — best for mortality risk and disposition decisions, but may miss early deterioration.
- SMART-COP: Designed to detect who will crash — flags need for respiratory support and ICU-level care that other scores may miss.
Post Peer Reviewed By: Marco Propersi, DO (Twitter/X: @Marco_Propersi), and Mark Ramzy, DO (X: @MRamzyDO)
👤 Author
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