Giamello Jacopo Davide, Martini Gianpiero, Prato Davide, Santoro Marco, Arese Ylenia, Melchio Remo, Bertolaccini Luca, Battle Ceri Elisabeth, Driscoll Timothy, Sciolla Andrea, Lauria Giuseppe
School of Emergency Medicine, University of Turin; Department of Emergency Medicine, Santa Croce e Carle Hospital, Cuneo, Italy.
Department of Emergency Medicine, Santa Croce e Carle Hospital, Cuneo, Italy.
Injury. 2023 Jan;54(1):39-43. doi: 10.1016/j.injury.2022.08.028. Epub 2022 Aug 14.
Blunt thoracic trauma (BTT) is a leading cause of emergency department (ED) trauma-related attendance. Risk prediction tools are commonly to predict patients' outcomes and assign them to the most appropriate care setting. The STUMBL score is a prognostic model for BTT, derived and validated in the United Kingdom; items comprising the score are age, number of rib fractures, use of pre-injury anticoagulants, chronic lung disease and oxygen saturation levels. This study's aim was to validate the STUMBL score in an Italian ED.
This single-centre retrospective validation study was conducted in the ED of Santa Croce and Carle hub hospital in Cuneo, north-western Italy. All patients with an ED attendance for isolated BTT from 2018 to 2021 were included. Exclusion criteria were an 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 characteristic curve and calibration with the Hosmer-Lemeshow test and with the calibration belt.
745 patients were enroled (median age 64 [25th;75th percentile: 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 0.90 (95% CI 0.88-0.93), and the result of the Hosmer-Lemeshow test was 9.01 (p = 0.34). STUMBL score = 16 has a sensitivity of 0.80 (95% CI 0.75-0.85), specificity of 0.87 (95% CI 0.84-0.90), a positive predictive value of 0.70 (95% CI 0.64-0.76), and a negative predictive value of 0.92 (95% CI 0.90-0.94).
In this validation study, the STUMBL score demonstrated excellent discrimination and calibration in predicting the outcome of patients attending the ED with a BTT.
钝性胸部创伤（BTT）是急诊科（ED）创伤相关就诊的主要原因。风险预测工具通常用于预测患者的预后，并将他们分配到最合适的护理环境。STUMBL评分是一种针对BTT的预后模型，在英国得出并经过验证；构成该评分的项目包括年龄、肋骨骨折数量、伤前抗凝剂的使用、慢性肺病和血氧饱和度水平。本研究的目的是在意大利的急诊科验证STUMBL评分。
这项单中心回顾性验证研究在意大利西北部库内奥的圣十字与卡尔莱枢纽医院的急诊科进行。纳入了2018年至2021年因单纯BTT到急诊科就诊的所有患者。排除标准为年龄未满18岁以及存在任何立即危及生命的损伤。主要结局是创伤相关并发症的发生，定义为出现以下一种或多种情况：院内死亡、肺部并发症（感染、胸腔积液、血胸、气胸、脓胸）、需要入住重症监护病房、住院时间等于或大于7天。通过评估受试者工作特征曲线分析STUMBL评分的辨别能力，并通过Hosmer-Lemeshow检验和校准带进行校准。
共纳入745例患者（中位年龄64岁[第25；75百分位数：50；78]，男女比例1:4，中位Charlson合并症指数2[1；4]，中位STUMBL评分11[6；17]）。65.2%的患者在急诊科评估后出院回家。203例患者（27.2%）出现了主要结局。出现并发症的患者与未出现并发症的患者相比，STUMBL评分有显著差异（9[5；13]对21[17；25]，p<0.001）。主要结局评分的C指数为0.90（95%可信区间0.88 - 0.93），Hosmer-Lemeshow检验结果为9.01（p = 0.34）。STUMBL评分为16时，灵敏度为0.80（95%可信区间0.75 - 0.85），特异度为0.87（95%可信区间0.84 - 0.90），阳性预测值为0.70（95%可信区间0.64 - 0.76），阴性预测值为0.92（95%可信区间0.90 - 0.94）。
在这项验证研究中，STUMBL评分在预测因BTT到急诊科就诊患者的预后方面显示出出色的辨别能力和校准能力。
