Guiding rib fracture care with the STUMBL score: acute pain management and intensive care unit referrals.

Abstract

Background: Rib fractures are common after blunt chest trauma and are associated with significant morbidity, mortality, and prolonged hospital stays due to pulmonary complications. Effective pain management is crucial in preventing these complications. The 'STUdy of the Management of BLunt chest wall trauma' (STUMBL) score can identify patients with rib fractures at risk of complications and assist with Emergency Department (ED) disposition decisions. Its role in guiding Acute Pain Service (APS) and Intensive Care Unit (ICU) referrals was previously unexplored.

Design and objectives: We conducted a retrospective cohort study on adults with radiologically confirmed rib fractures who presented to The Royal Melbourne Hospital between April 2021 and March 2022. We aimed to assess the association between STUMBL scores and advanced analgesia prescription or ICU admission. Participants were categorised into five STUMBL groups (<11, 11-20, 21-25, 26-30, ≥31). The primary outcome of interest was regional analgesia insertion. The secondary outcomes were patient-controlled analgesia (PCA) use, APS and ICU referrals, and medical emergency team (MET) calls within 48 h. Modified Poisson regression was used to analyse associations, with the <11 group used as the reference.

Results: Among 344 participants, the median STUMBL score was 17 (interquartile range [IQR] 10-24). Higher STUMBL scores were strongly associated with regional analgesia insertion in the STUMBL 26-30 group (RR 15.3, 95 % CI 1.8-130.3, p = 0.013) and the STUMBL ≥31 group (RR 29.3, 95 % CI 4.0-212.5, p = 0.001). Significant associations were also observed for PCA prescription (RR 5.0, 95 % CI 2.6-9.7, p < 0.001), APS referral (RR 4.7, 95 % CI 2.7-8.1, p < 0.001), and ICU admission (RR 3.8, 95 % CI 2.0-6.9, p < 0.001) in the STUMBL ≥31 group.

Conclusion: The STUMBL score is a valuable tool for identifying patients likely to require advanced analgesia and APS input, with high scores strongly associated with regional analgesia insertion and PCA prescription. Additionally, patients with STUMBL scores ≥26 were more likely to require ICU admission. Incorporating STUMBL thresholds into rib fracture guidelines could facilitate early APS involvement, guide appropriate admission destinations, optimise hospital resource allocation and improve patient outcomes. Further studies should validate these findings in larger, multi centre cohorts and explore patient-reported outcomes.