Use of the patient at risk scores in the emergency department: a preliminary study

To assess the feasibility of using a modified patient at risk (PAR) scoring system in the emergency department.

Modified PAR scores were calculated for 30 triage category 1 and 2 patients on arrival in the department and at 15 minutes after the initial resuscitation was underway using observation datasheets designed for this project.

Three patients (10%) were admitted to the intensive care unit (ICU). Twenty six patients (88%) were admitted to a general ward and one was discharged. Fifty per cent of the patients had a PAR score of 3 or more on arrival. Eighty seven per cent of the general ward patients had a PAR score that was stable or improved during the first 15 minutes of resuscitation. The other three ward patients, whose scores deteriorated, were assessed in the emergency department by the appropriate teams and deemed appropriate for ward beds. Two of the three ICU patients deteriorated in the resuscitation room. The third ICU patient maintained a PAR score of 2 but had such overwhelming injuries that ICU was the only option.

Serial PAR scores are far more informative than isolated scores. This study suggests that serial PAR scores could be used in three ways in the emergency department. Firstly, in the assessment of individual patients and their response to initial resuscitation. Secondly, as a guide to the need further specialist assessment before leaving the emergency department. Finally, as an audit tool to measure the effectiveness of initial treatments in large numbers of patients during the initial resuscitation.