FTP1.1 Using the STUMBL score to assess blunt chest wall trauma - does improving accuracy lead to improved patient care?

Abstract

Abstract The STUMBL score is widely used to assess risk of complications in patients with blunt chest wall trauma. We audited its use in guiding the management of patients with rib fractures at a London major trauma centre. Methods This was a closed-loop audit. Data were collected retrospectively from electronic patient records for a period of one month (October 2021). Results were disseminated at the Regional Major Trauma Network Governance meeting. Educational updates were provided for the multidisciplinary team. After this intervention, a second one month audit cycle was completed (December 2021). Results Thirty-nine patients were included in cycle 1, of whom 41% (n=16) had care stratified using the STUMBL score. Calculation accuracy was poor: 0% had a correct score and 56.3% (n=9) had a score calculated within ±3 of the correct figure. Post-intervention, there was a significant improvement in STUMBL use in the 34 patients assessed in cycle 2: 85.3% (n=29; p=0.0001) had a documented score. Accuracy also improved, with 44.8% (n=13) within ±3 of correct and 31.0% (n=9) correct. There was no significant difference in the proportion of patients who were treated according to guidelines (74.3% vs 53.8%) or who were under-treated (23.1% vs. 38.2%) following our intervention (p=0.18). Conclusions We found a number of barriers to implementing the STUMBL score. Its use and calculation accuracy was improved by education, but this did not result in more patients following the suggested treatment pathway. Further evaluation is required to understand this discrepancy.