Blunt thoracic trauma is a major contributor to trauma-related morbidity and mortality worldwide. Common trauma scoring systems such as the Injury Severity Score (ISS) quantify overall trauma burden but may lack specificity for thoracic injury patterns. The Study of the Management of Blunt Chest Wall Trauma (STUMBL) score was developed to integrate clinical factors specific to chest wall injury — age, number of rib fractures, chronic lung disease, oxygen saturation, and pre-injury anticoagulant use — and to guide initial risk stratification. This study set out to validate the STUMBL score in an Indonesian tertiary hospital and to compare its prognostic performance with that of the ISS for predefined clinical outcomes.
A prospective cohort study was performed at Dr. Saiful Anwar General Hospital in Malang, Indonesia between February 2024 and April 2025. Inclusion criteria were adult patients (age ≥18 years) with confirmed blunt thoracic trauma and a Glasgow Coma Scale score of 14–15 on presentation. At admission, demographic, clinical, and radiologic variables were collected and both ISS and STUMBL scores were calculated.
Statistical analyses reported in the abstract included the Mann–Whitney U test for group comparisons and receiver operating characteristic (ROC) curve analysis to evaluate discriminative performance. The study defined key clinical outcomes as prolonged hospitalization (≥7 days), intensive care unit (ICU) admission, and in-hospital mortality.
A total of 371 patients met inclusion criteria. The cohort was predominately male (75.7%) with a median age of 43 years. Road traffic accidents accounted for the majority of blunt thoracic injuries (69.5%). ICU admission occurred in 18.3% of cases and the observed in-hospital mortality rate was 5.4%.
Three clinical endpoints were assessed:
Both the STUMBL and ISS scores were compared between patients with and without these outcomes, and ROC analysis was used to quantify predictive accuracy for each endpoint.
Both scoring systems were significantly higher among patients who experienced adverse outcomes (p<0.001 for all comparisons reported). However, the STUMBL score showed superior discriminative ability across the three outcomes. Reported area under the curve (AUC) values for STUMBL were:
In contrast, ISS demonstrated lower AUCs, reported in the abstract as ranging from 0.753 to 0.802, indicating reduced ability to discriminate patients at higher risk for these outcomes compared with STUMBL.
The authors report that a STUMBL cut-off value of >10.5 provided a balance of sensitivity and specificity for the evaluated outcomes. At that threshold, sensitivities ranged from approximately 70.0% to 74.1% and specificities ranged from 80.6% to 92.4% for prolonged hospitalization, ICU admission, and in-hospital mortality as reported in the abstract.
In this Indonesian tertiary hospital cohort of adults with blunt thoracic trauma, the STUMBL score outperformed the ISS for predicting prolonged hospitalization, need for ICU admission, and in-hospital mortality. The authors conclude that using the STUMBL score may improve early risk stratification and support clinical decision-making for patients with blunt chest wall injury in similar hospital settings.
Notes on source data and limitations: the summary and all numeric results above are taken from the article abstract. Details of full statistical methods, confidence intervals, calibration metrics, subgroup analyses, and potential study limitations were not reported in the abstract and would require consultation of the full text for further appraisal.