Hardin et al reported the Sequential Clinical Assessment of Respiratory Function (SCARF) Score for a patient with rib fractures. The authors are from the Denver Health Medical Center.
Patient selection: rib fracture
Parameters:
(1) incentive spirometry as percent of predicted for age, sex and height
(2) respiratory rate in breaths per minute
(3) numeric pain score (NPS) on numeric rating scale from 0 to 10
(4) strength of cough
Parameter
Finding
Points
incentive spirometry
>= 50% of predicted
0
< 50% of predicted
1
respiratory rate
<= 20 breaths per minute
0
> 20 breaths per minute
1
numeric pain score
< 5
0
>= 5
1
cough
adequate to clear secretions
0
inadequate to clear secretions
1
total score =
= SUM(points for all 4 parameters)
Interpretation:
• minimum score: 0
• maximum score: 4
• The higher the SCARD score the worse the outcomes (ICU length of stay, pneumonia, etc).
• The score can be determined on admission, by trend analysis, or as a maximum.
• A score of 3 or 4 is considered significant.
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