From Department of Surgery (K.S.H., K.N.L., J.H. E.E.M., C.C.B., F.M.P), Division of Trauma & Surgical Critical Care, Denver Health Medical Center, Denver, Colorado.
J Trauma Acute Care Surg. 2019 Dec;87(6):1260-1268. doi: 10.1097/TA.0000000000002480.
Rib fracture scoring systems are limited by a lack of serial pulmonary physiologic variables. We created the Sequential Clinical Assessment of Respiratory Function (SCARF) score and hypothesized that admission, maximum, and rising scores predict adverse outcomes among critically ill rib fracture patients.
Prospective cohort study of rib fracture patients admitted to the surgical intensive care unit (ICU) at a Level I trauma center from August 2017 to June 2018. The SCARF score was developed a priori and validated using the cohort. One point was assigned for: <50% predicted, respiratory rate >20, numeric pain score ≥5, and inadequate cough. Demographics, injury patterns, analgesics, and adverse pulmonary outcomes were abstracted. Performance characteristics of the score were assessed using the receiver operator curve area under the curve.
Three hundred forty scores were available from 100 patients. Median admission and maximum SCARF score was 2 (range 0-4). Likelihood of pneumonia (p = 0.04), high oxygen requirement (p < 0.01), and prolonged ICU length of stay (p < 0.01) were significantly associated with admission and maximum scores. The receiver operator curve area under the curve for the maximum SCARF score for these outcomes were 0.86, 0.76, and 0.79, respectively. In 10 patients, the SCARF score worsened from admission to day 2; these patients demonstrated increased likelihood of pneumonia (p = 0.04) and prolonged ICU length of stay (p = 0.07). Patients who developed complications maintained a SCARF score one point higher throughout ICU stay compared with patients who did not (p = 0.04). The SCARF score was significantly associated with both narcotic (p = 0.03) and locoregional anesthesia (p = 0.03) usage.
Admission, maximum, daily, and rising scores were associated with utilization of pain control therapies and development of adverse outcomes. The SCARF score may be used to guide therapies for critically ill rib fracture patients, with a proposed threshold greater than 2.
Prognostic study, level II.
肋骨骨折评分系统因缺乏连续的肺部生理变量而受到限制。我们创建了连续临床评估呼吸功能（SCARF）评分，并假设入院时、最大值和升高的评分可预测危重症肋骨骨折患者的不良结局。
这是一项前瞻性肋骨骨折患者队列研究，这些患者于 2017 年 8 月至 2018 年 6 月期间入住一级创伤中心的外科重症监护病房（ICU）。SCARF 评分是预先制定的，并在队列中进行了验证。以下情况各记 1 分：<预计值的 50%、呼吸频率>20、数字疼痛评分≥5 和咳嗽无力。提取了患者的人口统计学、损伤模式、镇痛药物和不良肺部结局等信息。使用接收者操作曲线下的面积评估评分的性能特征。
从 100 名患者中获得了 340 个评分。中位入院时和最大 SCARF 评分为 2 分（范围 0-4）。肺炎的可能性（p = 0.04）、高氧需求（p < 0.01）和 ICU 住院时间延长（p < 0.01）与入院时和最大评分显著相关。最大 SCARF 评分对这些结局的接收者操作曲线下面积分别为 0.86、0.76 和 0.79。在 10 名患者中，SCARF 评分从入院到第 2 天恶化；这些患者发生肺炎的可能性增加（p = 0.04），ICU 住院时间延长（p = 0.07）。与没有发生并发症的患者相比，发生并发症的患者在 ICU 住院期间的 SCARF 评分始终高 1 分（p = 0.04）。SCARF 评分与阿片类药物（p = 0.03）和局部区域麻醉（p = 0.03）的使用显著相关。
入院时、最大值、每日和升高的评分与疼痛控制治疗的使用和不良结局的发生有关。SCARF 评分可用于指导危重症肋骨骨折患者的治疗，建议阈值大于 2。
预后研究，II 级。
