Aims
Rib fractures are the most common presentation of blunt chest trauma, with approximately 10% of patients requiring hospital admission. The STUMBL (STUdy of the Management of BLunt chest trauma) score was developed to guide admission decisions, but its ability to predict mortality and geriatric-relevant outcomes is uncertain. This study evaluated whether the STUMBL score stratifies risk for mortality, delirium, and discharge destination in adults aged ≥65 years with rib fractures.
Methods
We conducted a retrospective single-centre cohort study of patients aged ≥65 years presenting with traumatic rib fractures to a Level 1 trauma centre between 1 January and 31 December 2022. The primary outcome was 90-day mortality. Secondary outcomes included delirium during admission, 12-month mortality, length of stay, functional decline, and failure to return home. Discrimination by STUMBL score was assessed using receiver operating characteristic analysis, with threshold performance evaluated at a prespecified cut-point (STUMBL ≥15).
Results
A total of 476 patients were included (mean age 78 years; median Clinical Frailty Scale 3). Higher STUMBL scores were independently associated with increased 90-day mortality (OR 1.03, 95% CI 1.01–1.05), delirium (OR 1.04, 95% CI 1.02–1.06), failure to return home (OR 1.05, 95% CI 1.03–1.07), and longer length of stay (OR 1.07, 95% CI 1.05–1.10; all p<0.01). A STUMBL score ≥15 demonstrated utility as a screening threshold for delirium and non-home discharge.
Conclusion
The STUMBL score is associated with mortality and geriatric-relevant morbidity in older adults with rib fractures and may support early involvement of specialist geriatric care.