Payrastre et al reported the SCRAP rule to determine if a patient with blunt thoracic trauma requires a chest CT exam. A chest CT exam may not be needed in carefully selected patients. The authors are from McMaster University in Hamilton, Ontario.
SCRAP is an acronym for saturation, chest radiograph, respiratory rate, auscultation and palpation.
Patient selection: blunt thoracic trauma, Glasgow coma score > 8, age >= 16 years, nonparalyzed, no penetrating injury
Parameters:
(1) oxygen saturation (S)
(2) chest radiograph
(3) respiratory rate in breaths per minute
(4) chest auscultation
(5) thoracic palpation
Parameter
Finding
Points
oxygen saturation
>= 95% on room air
0
< 95% on room air
1
>= 98% on supplemental oxygen
0
< 98% on oxygen
1
chest radiograph
normal
0
abnormal
1
respiratory ate
<= 24 breaths per minute
0
>= 25 breaths per minute
1
chest auscultation
normal
0
abnormal
1
thoracic palpation
no anterior or posterior tenderness or crepitus
0
any tenderness or crepitus
1
total score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 5
• A score of 0 indicates a patient who does not need a chest CT exam.
• A score >= 1 has a sensitivity of 100% for detecting significant trauma.
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