Trauma · ICU and Critical Care · Surgery

Sequential Clinical Assessment of Respiratory Function (SCARF) Score calculator

Enter the published formula inputs below to calculate and interpret this score.

Clinical inputs

Incentive spirometry below 50% of predictedRespiratory rate above 20 per minuteNumeric pain score 5 or greaterInadequate cough

Result

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Low risk (score 0)

Band: Low risk (score 0)

Interpretation. Low risk (score 0)

Suggested management. The source places a score of 0 in its low-risk tier. Repeat the score daily, because the source used the admission and maximum scores.

Primary source

Hardin KS, Leasia KN, Haenel J, Moore EE, Burlew CC, Pieracci FM. The Sequential Clinical Assessment of Respiratory Function (SCARF) score: a dynamic pulmonary physiologic score that predicts adverse outcomes in critically ill rib fracture patients. J Trauma Acute Care Surg. 2019;87(6):1260-1268. DOI: 10.1097/TA.0000000000002480. PMID: 31425473. One point each, equally weighted: incentive spirometry less than 50% of predicted (nomogram using sex, height and age), respiratory rate above 20, numeric pain score of 5 or greater, and cough judged inadequate to clear secretions by respiratory therapists. Range 0 to 4, scored on admission and daily. The abstract gives a proposed threshold greater than 2. Maximum-score AUC was 0.86 for pneumonia; no patient with an admission score under 2 or a maximum score under 3 developed pneumonia. The Discussion proposes low risk at 0, intermediate risk at 1-2 and high risk at 3-4, and says a persistently high score may be a threshold for more aggressive therapies including ICU admission, locoregional pain control and surgical stabilisation of rib fractures. Single-centre cohort of 100 ICU patients. (2019)

Scope: Adults with rib fractures in intensive care, scored on admission and repeated daily. It is not validated outside the single derivation centre or for patients without rib fractures.

Last reviewed 2026-10-18

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Sequential Clinical Assessment of Respiratory Function (SCARF) Score: 0 — Low risk (score 0). Interpretation: Low risk (score 0) What to do: The source places a score of 0 in its low-risk tier. Repeat the score daily, because the source used the admission and maximum scores. Inputs: Incentive spirometry below 50% of predicted: false; Respiratory rate above 20 per minute: false; Numeric pain score 5 or greater: false; Inadequate cough: false Source: Hardin KS, Leasia KN, Haenel J, Moore EE, Burlew CC, Pieracci FM. The Sequential Clinical Assessment of Respiratory Function (SCARF) score: a dynamic pulmonary physiologic score that predicts adverse outcomes in critically ill rib fracture patients. J Trauma Acute Care Surg. 2019;87(6):1260-1268. DOI: 10.1097/TA.0000000000002480. PMID: 31425473. One point each, equally weighted: incentive spirometry less than 50% of predicted (nomogram using sex, height and age), respiratory rate above 20, numeric pain score of 5 or greater, and cough judged inadequate to clear secretions by respiratory therapists. Range 0 to 4, scored on admission and daily. The abstract gives a proposed threshold greater than 2. Maximum-score AUC was 0.86 for pneumonia; no patient with an admission score under 2 or a maximum score under 3 developed pneumonia. The Discussion proposes low risk at 0, intermediate risk at 1-2 and high risk at 3-4, and says a persistently high score may be a threshold for more aggressive therapies including ICU admission, locoregional pain control and surgical stabilisation of rib fractures. Single-centre cohort of 100 ICU patients. (2019)

Professional use only

For qualified clinicians. Independently verify inputs, calculations, source guidance, and applicability before any clinical action. This calculator does not replace clinical judgment.

Source: Hardin KS, Leasia KN, Haenel J, Moore EE, Burlew CC, Pieracci FM. The Sequential Clinical Assessment of Respiratory Function (SCARF) score: a dynamic pulmonary physiologic score that predicts adverse outcomes in critically ill rib fracture patients. J Trauma Acute Care Surg. 2019;87(6):1260-1268. DOI: 10.1097/TA.0000000000002480. PMID: 31425473. One point each, equally weighted: incentive spirometry less than 50% of predicted (nomogram using sex, height and age), respiratory rate above 20, numeric pain score of 5 or greater, and cough judged inadequate to clear secretions by respiratory therapists. Range 0 to 4, scored on admission and daily. The abstract gives a proposed threshold greater than 2. Maximum-score AUC was 0.86 for pneumonia; no patient with an admission score under 2 or a maximum score under 3 developed pneumonia. The Discussion proposes low risk at 0, intermediate risk at 1-2 and high risk at 3-4, and says a persistently high score may be a threshold for more aggressive therapies including ICU admission, locoregional pain control and surgical stabilisation of rib fractures. Single-centre cohort of 100 ICU patients. (2019)

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Clinical inputs

Incentive spirometry below 50% of predicted
Respiratory rate above 20 per minute
Numeric pain score 5 or greater
Inadequate cough

Primary source

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