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Sequential Clinical Assessment of Respiratory Function (SCARF) Score

Bedside physiologic score for adverse outcomes in rib fracture patients.

Sequential Clinical Assessment of Respiratory Function (SCARF) Score
Incentive spirometry <50% predicted
Respiratory rate >20/min
Numeric pain score ≥5
Inadequate/weak cough
Result0 points

Lower physiologic burden; reassess serially as fractures evolve.

When to use

  • Serial bedside reassessment of pulmonary physiology in critically ill rib fracture patients to guide analgesia and respiratory therapy escalation.

Formula

1 point each for: incentive spirometry <50% predicted, respiratory rate >20, pain score ≥5, inadequate cough. Range 0-4.

Pearls and pitfalls

  • Intended for repeated (not one-time) assessment — a rising score over time is itself a warning sign.

References

  1. Hardin KS, et al. J Trauma Acute Care Surg. 2019;87(6):1260-1268.