Assessment scores in H1N1 infection

We recently published our prospective series with 53 H1N1 pneumonia patients and used the SMART-COP score with good results [3]. We compared the STSS and the SMART-COP in our sample. Due to the distribution of our sample, we reported data as medians with ranges for continuous variables using the Kruskal-Wallis test and the Mann-Whitney test for the STSS and SMART-COP scores, respectively. For categorical variables we used the chi-square test or Fisher's exact test, and the results are reported as absolute values and percentages.Overall, the SMART-COP was a better tool for screening ICU admission and/or in-hospital case fatality compared with the STSS score in our patients with H1N1 pneumonia. The SMART-COP had higher sensibility and negative predictive values with consequently better accuracy than the STSS score: 92% versus 71.4%, 90.4% versus 85.7%, and 83% versus 68%, respectively. Results are expressed in Table 1. On the contrary, the STSS score was more specific and had a higher positive predictive value for ICU admission and/or in-hospital case fatality compared with the SMART-COP. Considering that the SMART-COP is an easy tool to use it could be combined with the STSS for better prediction of outcomes in these patients.Kayode A Adeniji and Rebecca CusackWe agree with and appreciate the comments from Brand？o-Neto and colleagues concerning the SMART-COP triage tool, which appears to show a good binary determination of mortality and ICU admission in a young (mean age 43) population of H1N1 patients at their institution.However, we continue to assert that a triage tool needs to be applicable to all levels of triage (primary to tertiary) [1]. There will always be concern in a disaster situation that we may not have recourse to imaging and laboratory data to inform our triage instrument-guided decision-making. The SMART-COP requires a chest X-ray, serum albumin levels, arterial pH and arterial partial pressure of oxygen measurements which may limit its efficacy in t