Effectiveness of the STUMBL Scoring System in Predicting Outcomes of Blunt Chest Trauma Patients Admitted to the Trauma ICU: A Retrospective Cohort Study

Introduction: Blunt chest trauma is one of the leading causes of trauma related admission to the Emergency Department (ED). Risk prediction tools are widely used to estimate patient outcomes and guide clinical decision making. The Study of Management of Blunt Chest Wall Trauma (STUMBL) (Study of Management of Blunt chest wall trauma) score is a prognostic score developed to aid in the management of patients presenting with blunt chest injuries in the ED. Aim: The present study aimed to evaluate the STUMBL scoring system to predict the outcomes in blunt chest trauma patients admitted to the trauma ICU. Materials and Methods: The present retrospective analysis was conducted on adult blunt chest trauma patients admitted to the trauma ICU between January 2023 and January 2024. Patients less than 18 years of age, severe head injury and life threatening polytrauma were excluded from the study. Patient demographics, STUMBL scores, clinical interventions and outcomes were analysed. Results: A total of 99 patients were enrolled in the study. The mean (SD) age was 44.83 (14.87) years, with a male/female ratio of 10:1 and a median Charlson comorbidity index of 0.50 (0.00, 2.00). Blunt chest trauma from road traffic accidents accounted for 76 (82.61%) of cases. Isolated blunt chest trauma was observed in 32 (32.32%) of patients and 95 (95.9%) patients had at least one rib fracture. The mean (SD) STUMBL score was 23.26 (11.65). There was a statistically significant association between higher STUMBL scores and the need for ventilatory support. Patients requiring NIV had significantly higher STUMBL scores (p=0.0002). STUMBL score>=26 had sensitivity of 68.00%, specificity of 67.65%, positive likelihood ratio of 2.10 and negative likelihood ratio of 0.47. Similarly, for HFNC use, Score>=26, had sensitivity of 60.98%, specificity of 72.55%, positive likelihood ratio of 2.22 and negative likelihood ratio of 0.53(p=0.0018). Higher STUMBL score were also significantly associated with longer ICU stay (p=0.0104) with a positive correlation (Spearman’s rho=0.2709). Conclusion: The STUMBL score demonstrated good discrimination in predicting the need for ventilatory support (NIV/ HFNC) and longer ICU stay in patients with blunt chest trauma admitted to trauma ICU. A score of >/=26 was associated with increased need for respiratory support and prolonged ICU length of stay. These findings support the utility of the STUMBL score as a valuable prognostic tool in guiding early management decisions for blunt chest trauma patients in the ICU setting.