Blunt thoracic trauma (BTT) is a significant cause of morbidity and mortality in
emergency department (ED) patients worldwide. The complexity of BTT management arises
from the diverse range of injuries that can occur, including rib fractures, pneumothorax,
and hemothorax, which can lead to life-threatening complications if not promptly
identified and treated. Studies indicate that the rise in mortality and long-term
morbidity can be clearly linked to the number of rib fractures sustained. Road traffic
collisions are the predominant cause of major blunt injury. BTT is more common, with
relative incidence being estimated at 72-83.5% versus penetrating trauma at 16.5-28%. In
emergency settings, timely and accurate assessment of patients with blunt thoracic
injuries is crucial for optimizing outcomes. Thereby, there is a need for valid systems
that can be effectively utilized in emergency departments to enhance clinical
decision-making in a short-term manner.
The STUMBL (STUdy of the Management of BLunt chest wall trauma) score was developed to
assist in clinical decision-making for patients with blunt chest wall trauma. This model
includes five risk factors: patient age, the number of rib fractures, chronic lung
disease, pre-injury use of anticoagulants, and oxygen saturation levels. Unlike other
scoring systems that focus solely on anatomical variables and age, the STUMBL score
uniquely incorporates clinical variables such as chronic lung disease and
anticoagulation. A huge benefit of the STUMBL score is that these variables are all
routinely measured in the ED. The score has reached a sensitivity of 80%, a specificity
of 96%, a positive predictive value (PPV) of 93%, and a negative predictive value (NPV)
of 86% for predicting complications following blunt chest wall trauma. By integrating
essential clinical parameters, the STUMBL score helps clinicians identify patients at
high risk for adverse outcomes. Each patient is evaluated based on several risk factors.
A final risk score of ≥11 indicates a significant risk of developing complications, and a
total risk score exceeding 25 is considered sufficiently high to require admission to the
intensive care unit (ICU).
The STUMBL score has shown potential across various healthcare settings. However, its
validation in varied populations, especially in low-resource areas, remains limited. In
the context of Iraqi EDs, the applicability of the STUMBL score has not been thoroughly
investigated. As healthcare systems face challenges related to resource, training, and
infrastructure limitations, the integration of evidence-based tools like the STUMBL score
could significantly improve patient care. The burden of trauma is compounded by ongoing
conflict and limited healthcare resources, leading to an urgent need for effective trauma
management protocols. This study aims to evaluate the performance of the STUMBL score
among ED patients presenting with blunt thoracic trauma in Iraq.
