The role of the STUMBL score as a tool for predictors of adverse outcomes in patients aged ≥ 65 who have sustained rib fractures

Introduction
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 unclear. 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. Threshold performance was 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). The mean STUMBL score was 24, and the median number of rib fractures was four. On multivariable regression, 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 strongly associated with mortality and geriatric-relevant morbidity in older adults with rib fractures and may support early risk stratification, admission planning, and earlier involvement of specialist geriatric care.