# Clinical Risk Stratification Using the STUMBL (STUdy of the Management of BLunt Chest Wall Trauma) Score in Blunt Chest Trauma: A Prospective Observational Study

## TL;DR

This study shows that the STUMBL score helps predict complication severity in patients with blunt chest trauma, aiding clinical decision-making.

## Contribution

The study demonstrates the STUMBL score's effectiveness in correlating with complication severity in blunt chest trauma patients.

## Key findings

- Higher STUMBL scores were significantly associated with increased complication severity (χ² = 65.2, p < 0.001).
- Patients with STUMBL scores ≥ 16 had more severe complications and higher resource utilization.
- The STUMBL score may serve as a useful clinical risk stratification tool for blunt chest trauma.

## Abstract

Background: Blunt chest trauma is a common cause of emergency department presentation. It is associated with a broad spectrum of clinical outcomes, ranging from minor chest wall injuries to life-threatening respiratory complications. Early risk stratification remains challenging, and reliance on clinical judgment alone may fail to identify patients at risk of deterioration. The STUMBL (STUdy of the Management of BLunt chest wall trauma) score was developed as a bedside tool to stratify risk in such patients; however, data correlating STUMBL score strata with graded complication severity remain limited.

Methods: This prospective observational cohort study was conducted at a tertiary care teaching hospital in India and included consecutive patients presenting with blunt chest trauma to the emergency department over 18 months. STUMBL scores were calculated on presentation. Patients were followed throughout hospitalization to assess clinical outcomes, including complications, intensive care unit (ICU) admission, length of hospital stay, and in-hospital mortality. Complication severity was graded using the Clavien-Dindo classification. The primary outcome was in-hospital complication severity graded using the Clavien-Dindo classification on day 3 of admission.

Results: Ninety patients were included in the analysis. The mean STUMBL score was 5.6 ± 6.7 (range: 1-39). A significant association was observed between STUMBL score categories and Clavien-Dindo complication severity on day 3 (χ² = 65.2, p < 0.001). Patients with STUMBL scores ≥ 16 demonstrated a marked escalation in complication severity and resource utilization.

Conclusions: The higher STUMBL score categories were significantly associated with increased in-hospital complication severity and greater healthcare resource utilization. The STUMBL score may serve as a useful clinical risk stratification tool in patients with blunt chest trauma. Further multicenter studies with larger sample sizes are warranted to validate these findings.