Emergency Department, Capital and Coast District Health Board, Wellington, New Zealand.
Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
Emerg Med Australas. 2021 Oct;33(5):841-847. doi: 10.1111/1742-6723.13740. Epub 2021 Feb 17.
To assess validity of the STUMBL score in New Zealand for complications of blunt chest trauma without multi-trauma and immediate life-threatening injuries.
A multi-centre, retrospective observational study was carried out in five EDs. Area under the receiver operating characteristic curve (AUROC) was calculated for all, early and late complications and ethnic sub-groups. Youden Index generated for each ROC was used to indicate cut scores for risks of complication, ICU admission, prolonged length of stay (LOS) and mortality.
A total of 445 patients were included. AUROC for all complications composite were (0.73, 95% confidence interval [CI] 0.68-0.77), mortality (0.92, 95% CI 0.89-0.94), ICU admissions (0.78, 95% CI 0.73-0.81) and prolonged LOS (0.80, 95% CI 0.76-0.83) were calculated. The score performed better in the New Zealand European (Pākehā) sub-group compared to Māori and Pasifika (AUROC [95% CI]: 0.80 [0.73-0.85], 0.69 [0.56-0.79], 0.66 [0.46-0.82], respectively). Patients with scores >12 were at risk of complications from blunt chest trauma, >15 at risk of prolonged LOS and >18 at risk of ICU admission and mortality.
The STUMBL score at a cut-off of <12 did not predict all complications sufficiently well to recommend for general use in our population. However, a score >15 predicted prolonged LOS and a score >18 predicted mortality sufficiently to be clinically useful for these outcomes. The score is more accurate in New Zealand Pākehā and needs to be used with caution in Māori and Pasifika populations. A larger prospective validation is required to further assess the score.
评估 STUMBL 评分在新西兰用于无多发伤和即时生命威胁性损伤的钝性胸部创伤并发症的有效性。
在五家急诊室进行了一项多中心、回顾性观察性研究。计算了所有、早期和晚期并发症以及种族亚组的受试者工作特征曲线（ROC）下面积（AUROC）。每个 ROC 的约登指数用于指示并发症、入住 ICU、延长住院时间（LOS）和死亡率风险的截断分数。
共纳入 445 例患者。所有并发症综合的 AUROC 为（0.73，95%置信区间[CI]0.68-0.77），死亡率（0.92，95%CI0.89-0.94），ICU 入院（0.78，95%CI0.73-0.81）和延长 LOS（0.80，95%CI0.76-0.83）。该评分在新西兰欧洲裔（Pākehā）亚组中的表现优于毛利人和太平洋岛民（AUROC[95%CI]：0.80[0.73-0.85]、0.69[0.56-0.79]、0.66[0.46-0.82]）。评分>12 分的患者有发生钝性胸部创伤并发症的风险，评分>15 分的患者有延长 LOS 的风险，评分>18 分的患者有入住 ICU 和死亡的风险。
STUMBL 评分在截断值<12 时未能充分预测所有并发症，不推荐在我们的人群中常规使用。然而，评分>15 分可预测延长 LOS，评分>18 分可预测死亡率，对于这些结果具有足够的临床实用性。该评分在新西兰欧洲裔中更为准确，在毛利人和太平洋岛民中使用时需要谨慎。需要更大规模的前瞻性验证来进一步评估该评分。
