Webb Melissa, Kimmel Lara, Johnny Cecil, Holland Anne
Allied Health Executive, Alfred Health, Melbourne, Victoria, Australia.
Allied Health Executive, Alfred Health, Melbourne, Victoria, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Central Clinical School, Faculty of Medicine, Nursing and Health Science, Monash University, Melbourne, Victoria, Australia.
Injury. 2025 May;56(5):112088. doi: 10.1016/j.injury.2024.112088. Epub 2024 Dec 13.
Chest trauma is a common presentation to major trauma centres. Risk assessment tools have proven useful to support decision making in this group and the STUMBL (STUdy of the Management of BLunt chest wall trauma) score is one such measure that has been increasingly utilised. The aim of this study was to retrospectively validate the STUMBL score in an Australian population of patients admitted following chest trauma.
A single-centre retrospective validation study was undertaken using information from all patients with an Emergency Department (ED) attendance for isolated blunt chest trauma at a major trauma centre in Australia from 2018. The performance of the STUMBL score was measured including the cut-off score which best predicted 1) the discharge disposition from ED (ward or intensive care unit [ICU]), 2) the development of pulmonary complications, 3) an extended length of stay (LOS) (7 days or more) and 4) any complication (pulmonary, extended LOS, in hospital mortality). The performance measures included sensitivity, specificity, negative and positive predictive values as well discrimination and calibration.
There were 300 patients admitted between 1st January 2018 and 31st December 2018 with a median age of 60 years (IQR 44-75) and 65 % were male. The risk prediction cut-off score for our patient cohort ranged from 18.5 for LOS 7 days or more to 11.5 for ward admission from ED. The positive predictive value (PPV) ranged from 56.7 % for ward admission from ED to 21.1 % for pulmonary complications. The negative predictive value (NPV) and sensitivity was highest for ICU admission from ED (96.5 % and 80.6 %) and the specificity ranged from 78 % for all complication prediction to 65.3 % for LOS of 7 or more days. The C statistic ranged from 0.82 for ICU admission to 0.65 for pulmonary morbidity.
The performance measures of the STUMBL score are suboptimal in our population. The best performing measure was the ability to predict ICU admission. Further validation work that includes additional factors may improve the positive predictive value and clinical utility of the score in our cohort.
胸部创伤是大型创伤中心常见的就诊情况。风险评估工具已被证明有助于支持该类患者的决策制定，而STUMBL（钝性胸壁创伤管理研究）评分就是其中一项越来越常用的指标。本研究的目的是对澳大利亚胸部创伤后入院患者群体中的STUMBL评分进行回顾性验证。
采用澳大利亚一家大型创伤中心2018年以来所有因单纯钝性胸部创伤到急诊科就诊患者的信息进行单中心回顾性验证研究。对STUMBL评分的表现进行评估，包括能最佳预测以下情况的截断分数：1）从急诊科出院的去向（病房或重症监护病房[ICU]）；2）肺部并发症的发生；3）延长住院时间（LOS）（7天或更长时间）；4）任何并发症（肺部、延长住院时间、院内死亡）。性能指标包括敏感性、特异性、阴性和阳性预测值以及鉴别力和校准度。
2018年1月1日至2018年12月31日期间有300例患者入院，中位年龄为60岁（四分位间距44 - 75），65%为男性。我们患者队列的风险预测截断分数范围从延长住院时间7天或更长时间时的18.5分至从急诊科转入病房时的11.5分。阳性预测值（PPV）范围从从急诊科转入病房时的56.7%到肺部并发症时的21.1%。急诊科转入ICU时的阴性预测值（NPV）和敏感性最高（分别为96.5%和80.6%），特异性范围从所有并发症预测时的78%到延长住院时间7天或更长时间时的65.3%。C统计量范围从ICU入院时的0.82到肺部发病时的0.65。
在我们的患者群体中，STUMBL评分的性能指标并不理想。表现最佳的指标是预测ICU入院的能力。纳入更多因素的进一步验证工作可能会提高该评分在我们队列中的阳性预测值和临床实用性。
