Article Text
PDF
Abstract
Aims, Objectives and Background Blunt thoracic trauma (BTT) is a leading cause of emergency department (ED) trauma-related attendance. The STUMBL score is a prognostic model for BTT, derived and validated in the United Kingdom; this study’s aim was to validate the STUMBL score in an Italian ED.
Method and Design This single-centre retrospective validation study was conducted in the ED of Cuneo hospital, north-western Italy. All patients with an ED attendance for isolated BTT from 2018 to 2021 were included. Exclusion criteria were: 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 characteristiccurve and calibration with the Hosmer-Lemeshow test and with the calibration belt.
Results and Conclusion 745 patients were enrolled (median age 64 [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 0.9 (95% CI 0.88 – 0.93) (figure 1), and the result of the Hosmer-Lemeshow test was 9.01 (p=0.34). STUMBL score = 16 had a negative predictive value of 0.92. In conclusion, this validation study demonstrated that the STUMBL score had excellent discrimination and calibration in predicting the outcome of patients attending the ED with a BTT.