Risk stratification in older adults with rib fractures: Performance of the STUMBL score.

Abstract

Rib fractures are the most common injury following blunt chest trauma, with around 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 in older adults is unclear. We evaluated whether the STUMBL score stratifies risk for mortality, delirium, and discharge destination in adults aged ≥ 65 years. 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 3-month mortality. Secondary outcomes included delirium, 12-month mortality, length of stay, functional decline, and failure to return to usual place of residence. Discrimination was assessed using receiver operating characteristic analysis, and threshold performance was evaluated at a clinically used cut-point (STUMBL >15). Among 476 patients (mean age 77.8 years [SD 10.3]; median Clinical Frailty Scale 3 IQR [2-5]), the mean STUMBL score was 24.1 (SD 12.3). Higher STUMBL scores were independently associated with 3-month mortality (OR 1.03, 95% CI 1.01-1.05), delirium (OR 1.04, 95% CI 1.02-1.06), failure to return to usual place of residence (OR 1.05, 95% CI 1.03-1.07), and longer length of stay (all p < 0.01). A STUMBL score > 15 demonstrated high sensitivity but low specificity as a screening threshold for delirium and not returning to usual place of residence on discharge. The STUMBL score is associated with mortality and geriatric-relevant morbidity in older adults with rib fractures. In conjunction with assessment of frailty and cognition, it may support early risk stratification and care planning, including timely geriatric specialist involvement.