Highlights
- •The STUMBL score is a prognostic model for patients with blunt thoracic trauma, derived and externally validated in the United Kingdom.
- •Given the paucity of studies in this field, there is an urgent need to validate a predictive tool for patients with blunt thoracic trauma.
- •In this validation study, the STUMBL score demonstrated an excellent performance in predicting outcomes of patients with blunt thoracic trauma.
Abstract
Introduction
Blunt thoracic trauma (BTT) is a leading cause of emergency department (ED) trauma-related
attendance. Risk prediction tools are commonly to predict patients' outcomes and assign
them to the most appropriate care setting. The STUMBL score is a prognostic model
for BTT, derived and validated in the United Kingdom; items comprising the score are
age, number of rib fractures, use of pre-injury anticoagulants, chronic lung disease
and oxygen saturation levels. This study's aim was to validate the STUMBL score in
an Italian ED.
Methods
This single-centre retrospective validation study was conducted in the ED of Santa
Croce and Carle hub hospital in Cuneo, north-western Italy. All patients with an ED
attendance for isolated BTT from 2018 to 2021 were included. Exclusion criteria were
an age of under eighteen and the presence of any immediately life-threatening lesion.
The primary outcome was the development of trauma-related complications, defined by
the occurrence of one or more of the following: in-hospital mortality, pulmonary complications
(infection, pleural effusion, haemothorax, pneumothorax, pleural empyema), need for
intensive care unit admission, hospital length of stay equal to or greater than seven
days. The performance of the STUMBL score was analysed in terms of discrimination
with the evaluation of the receiver operating characteristic curve and calibration
with the Hosmer-Lemeshow test and with the calibration belt.
Results
745 patients were enroled (median age 64 [25th;75th percentile: 50;78], male/female
ratio 1:4, median Charlson comorbidity index 2 [1;4], median STUMBL score 11 [6;17]).
65.2% of patients were discharged home after ED evaluation. 203 patients (27.2%) developed
the primary outcome. The STUMBL score was significantly different in patients with
complications compared to those without complications (9 [5;13] vs 21 [17;25], p < 0.001). The C index of the score for the primary outcome was 0.90 (95% CI 0.88–0.93),
and the result of the Hosmer-Lemeshow test was 9.01 (p = 0.34). STUMBL score = 16 has a sensitivity of 0.80 (95% CI 0.75–0.85), specificity
of 0.87 (95% CI 0.84–0.90), a positive predictive value of 0.70 (95% CI 0.64–0.76),
and a negative predictive value of 0.92 (95% CI 0.90–0.94).
Conclusion
In this validation study, the STUMBL score demonstrated excellent discrimination and
calibration in predicting the outcome of patients attending the ED with a BTT.
Keywords
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Article info
Publication history
Published online: August 13, 2022
Accepted:
August 12,
2022
Footnotes
The study was not supported by any external funding.
Identification
Copyright
© 2022 Elsevier Ltd. All rights reserved.
