{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T19:52:48Z","timestamp":1793735568969,"version":"4.6.1"},"reference-count":15,"publisher":"Springer Science and Business Media LLC","issue":"6","license":[{"start":{"date-parts":[[2022,6,23]],"date-time":"2022-06-23T00:00:00Z","timestamp":1655942400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,6,23]],"date-time":"2022-06-23T00:00:00Z","timestamp":1655942400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100012352","name":"Universit\u00e0 degli Studi di Milano","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100012352","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Intern Emerg Med"],"published-print":{"date-parts":[[2022,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>The STUMBL (STUdy of the Management of BLunt chest wall trauma) score is a new prognostic score to assist ED (Emergency Department) decision making in the management of blunt chest trauma. This is a retrospective cohort chart review study conducted in a UK University Hospital ED seeing 120,000 patients a year, comparing its performance characteristics to ED clinician judgement. All blunt chest trauma patients that presented to our ED over a 6-month period were included. Patients were excluded if age\u2009&lt;\u200918, if they had immediate life-threatening injury, required critical care admission for other injuries or in case of missing identification data. Primary endpoint was complication defined as any of lower respiratory tract infection, pulmonary consolidation, empyema, pneumothorax, haemothorax, splenic or hepatic injury and 30-day mortality. Clinician judgement (clinician decision to admit) and STUMBL score were compared using the receiver-operating curve (ROC) and sensitivity analysis. Three hundred and sixty-nine patients were included. ED clinicians admitted 95 of 369 patients. ED clinician decision to admit had a sensitivity of 83.9% and specificity of 86.0% for predicting complications. STUMBL score\u2009\u2265\u200911 had a sensitivity of 79.0% and specificity of 77.9% for the same and would have led to 117 of 369 patients being admitted. Area under the curve (AUC) of STUMBL score and ED clinician decision to admit was 0.84 (95% CI 0.78\u20130.90) and 0.85 (95% CI 0.79\u20130.91), respectively. Our findings show that a STUMBL score\u2009\u2265\u200911 performs no better than ED clinician judgement and leads to more patients being admitted to hospital.<\/jats:p>","DOI":"10.1007\/s11739-022-03001-0","type":"journal-article","created":{"date-parts":[[2022,6,23]],"date-time":"2022-06-23T20:36:31Z","timestamp":1656016591000},"page":"1785-1793","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["The clinical effectiveness of the STUMBL score for the management of ED patients with blunt chest trauma compared to clinical evaluation alone"],"prefix":"10.1007","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5914-8072","authenticated-orcid":false,"given":"Elena","family":"Callisto","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6391-3849","authenticated-orcid":false,"given":"Giorgio","family":"Costantino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4191-9024","authenticated-orcid":false,"given":"Andrew","family":"Tabner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4465-9048","authenticated-orcid":false,"given":"Dean","family":"Kerslake","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1308-4824","authenticated-orcid":false,"given":"Matthew J.","family":"Reed","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,6,23]]},"reference":[{"issue":"3","key":"3001_CR1","doi-asserted-by":"publisher","first-page":"R98","DOI":"10.1186\/cc13873","volume":"18","author":"C Battle","year":"2014","unstructured":"Battle C, Hutchings H, Lovett S, Bouamra O, Jones S, Sen A, Gagg J, Robinson D, Hartford-Beynon J, Williams J, Evans A (2014) Predicting outcomes after blunt chest wall trauma: development and external validation of a new prognostic model. Crit Care 18(3):R98. https:\/\/doi.org\/10.1186\/cc13873","journal-title":"Crit Care"},{"key":"3001_CR2","doi-asserted-by":"publisher","first-page":"3257846","DOI":"10.1155\/2016\/3257846","volume":"2016","author":"A Bellone","year":"2016","unstructured":"Bellone A, Bossi I, Etteri M, Cantaluppi F, Pina P, Guanziroli M, Bianchi A, Casazza G (2016) Factors associated with ICU admission following blunt chest trauma. Can Respir J 2016:3257846. https:\/\/doi.org\/10.1155\/2016\/3257846","journal-title":"Can Respir J"},{"issue":"3","key":"3001_CR3","doi-asserted-by":"publisher","first-page":"450","DOI":"10.1510\/icvts.2009.206599","volume":"9","author":"R Demirhan","year":"2009","unstructured":"Demirhan R, Onan B, Oz K, Halezeroglu S (2009) Comprehensive analysis of 4205 patients with chest trauma: a 10-year experience. Interact Cardiovasc Thorac Surg 9(3):450\u2013453. https:\/\/doi.org\/10.1510\/icvts.2009.206599","journal-title":"Interact Cardiovasc Thorac Surg"},{"issue":"1","key":"3001_CR4","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1016\/j.injury.2011.12.012","volume":"44","author":"CE Battle","year":"2013","unstructured":"Battle CE, Hutchings H, Evans PA (2013) Expert opinion of the risk factors for morbidity and mortality in blunt chest wall trauma: results of a national postal questionnaire survey of Emergency Departments in the United Kingdom. Injury 44(1):56\u201359. https:\/\/doi.org\/10.1016\/j.injury.2011.12.012","journal-title":"Injury"},{"issue":"5","key":"3001_CR5","doi-asserted-by":"publisher","first-page":"586","DOI":"10.1016\/j.injury.2007.10.021","volume":"39","author":"GE Blecher","year":"2008","unstructured":"Blecher GE, Mitra B, Cameron PA, Fitzgerald M (2008) Failed Emergency Department disposition to the ward of patients with thoracic injury. Injury 39(5):586\u2013591. https:\/\/doi.org\/10.1016\/j.injury.2007.10.021","journal-title":"Injury"},{"issue":"1","key":"3001_CR6","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/j.injury.2011.01.004","volume":"43","author":"CE Battle","year":"2012","unstructured":"Battle CE, Hutchings H, Evans PA (2012) Risk factors that predict mortality in patients with blunt chest wall trauma: a systematic review and meta-analysis. Injury 43(1):8\u201317. https:\/\/doi.org\/10.1016\/j.injury.2011.01.004","journal-title":"Injury"},{"issue":"3","key":"3001_CR7","doi-asserted-by":"publisher","first-page":"240","DOI":"10.1016\/s0735-6757(97)90004-8","volume":"15","author":"I Dubinsky","year":"1997","unstructured":"Dubinsky I, Low A (1997) Non-life-threatening blunt chest trauma: appropriate investigation and treatment. Am J Emerg Med 15(3):240\u2013243. https:\/\/doi.org\/10.1016\/s0735-6757(97)90004-8","journal-title":"Am J Emerg Med"},{"issue":"7","key":"3001_CR8","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2017-015972","volume":"7","author":"C Battle","year":"2017","unstructured":"Battle C, Abbott Z, Hutchings HA, O\u2019Neill C, Groves S, Watkins A, Lecky FE, Jones S, Gagg J, Body R, Evans PA (2017) Protocol for a multicentre randomised feasibility STUdy evaluating the impact of a prognostic model for Management of BLunt chest wall trauma patients: STUMBL trial. BMJ Open 7(7):e015972. https:\/\/doi.org\/10.1136\/bmjopen-2017-015972","journal-title":"BMJ Open"},{"issue":"10","key":"3001_CR9","doi-asserted-by":"publisher","first-page":"981","DOI":"10.1016\/j.injury.2010.08.004","volume":"41","author":"MA Ahmad","year":"2010","unstructured":"Ahmad MA, Delli Sante E, Giannoudis PV (2010) Assessment of severity of chest trauma: is there an ideal scoring system? Injury 41(10):981\u2013983. https:\/\/doi.org\/10.1016\/j.injury.2010.08.004","journal-title":"Injury"},{"key":"3001_CR10","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1016\/j.jss.2019.06.009","volume":"244","author":"J Seok","year":"2019","unstructured":"Seok J, Cho HM, Kim HH, Kim JH, Huh U, Kim HB, Leem JH, Wang IJ (2019) Chest trauma scoring systems for predicting respiratory complications in isolated rib fracture. J Surg Res 244:84\u201390. https:\/\/doi.org\/10.1016\/j.jss.2019.06.009","journal-title":"J Surg Res"},{"key":"3001_CR11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.jss.2018.03.025","volume":"229","author":"A Fokin","year":"2018","unstructured":"Fokin A, Wycech J, Crawford M, Puente I (2018) Quantification of rib fractures by different scoring systems. J Surg Res 229:1\u20138. https:\/\/doi.org\/10.1016\/j.jss.2018.03.025","journal-title":"J Surg Res"},{"issue":"2","key":"3001_CR12","doi-asserted-by":"publisher","first-page":"73","DOI":"10.1136\/emermed-2019-209143","volume":"37","author":"F Birse","year":"2020","unstructured":"Birse F, Williams H, Shipway D, Carlton E (2020) Blunt chest trauma in the elderly: an expert practice review. Emerg Med J 37(2):73\u201378. https:\/\/doi.org\/10.1136\/emermed-2019-209143","journal-title":"Emerg Med J"},{"issue":"3","key":"3001_CR13","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1186\/s41512-019-0060-y","volume":"22","author":"LE Cowley","year":"2019","unstructured":"Cowley LE, Farewell DM, Maguire S, Kemp AM (2019) Methodological standards for the development and evaluation of clinical prediction rules: a review of the literature. Diagn Progn Res 22(3):16. https:\/\/doi.org\/10.1186\/s41512-019-0060-y","journal-title":"Diagn Progn Res"},{"issue":"6","key":"3001_CR14","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0128233","volume":"10","author":"S Sanders","year":"2015","unstructured":"Sanders S, Doust J, Glasziou P (2015) A systematic review of studies comparing diagnostic clinical prediction rules with clinical judgment. PLoS ONE 10(6):e0128233. https:\/\/doi.org\/10.1371\/journal.pone.0128233","journal-title":"PLoS ONE"},{"issue":"18","key":"3001_CR15","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1186\/1757-7241-18-8","volume":"11","author":"M Brabrand","year":"2010","unstructured":"Brabrand M, Folkestad L, Clausen NG, Knudsen T, Hallas J (2010) Risk scoring systems for adults admitted to the emergency department: a systematic review. Scand J Trauma Resusc Emerg Med 11(18):8. https:\/\/doi.org\/10.1186\/1757-7241-18-8","journal-title":"Scand J Trauma Resusc Emerg Med"}],"container-title":["Internal and Emergency Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11739-022-03001-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11739-022-03001-0\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11739-022-03001-0.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,9]],"date-time":"2022-09-09T13:28:01Z","timestamp":1662730081000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11739-022-03001-0"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,23]]},"references-count":15,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2022,9]]}},"alternative-id":["3001"],"URL":"https:\/\/doi.org\/10.1007\/s11739-022-03001-0","relation":{},"ISSN":["1828-0447","1970-9366"],"issn-type":[{"value":"1828-0447","type":"print"},{"value":"1970-9366","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,6,23]]},"assertion":[{"value":"1 April 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 May 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"23 June 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"There are no conflicts of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"As per the NHS Health Research Authority flowchart (), this project was deemed to be service evaluation and so did not require formal Regional Ethics Committee review.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Not applicable.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}}]}}