The STUMBL Score is a clinical prediction model that has revolutionised the way that patients with potentially serious chest injuries are managed.
Developed by Professor Ceri Battle (a critical care and emergency medicine physiotherapist) as part of her PhD research with Swansea University’s Swansea Trials Unit (working alongside Professors Hayley Hutchings and Alan Watkins, Dr Claire O’Neill and Mr Tim Driscoll), the model scores 5 pieces of routinely collected clinical information, to predict the risk of the patient developing complications that would require further treatment.
Developing The Score
The need for a new intervention was first recognised by a group of clinicians, including Professor Battle, as patients were developing delayed complications, having not received optimal care during their first hospital visit.
To combat this issue directly, the Score was developed, to enable effective decision-making as to where a patient could be best treated. A low score can lead to a patient being safely discharged to recover at home, whereas a higher score can lead to interventions being needed on hospital wards, or even in intensive care.
The Score is now also routinely used to guide decisions on analgesia (pain relief), and referral to other specialist departments (such as physiotherapy, acute pain services or even anesthetics for invasive analgesia), radically improving patient care and outcomes.
Improving Care Across The UK
Since its development, the STUMBL Score has been widely adopted; now being used as a tool for guiding patient discharge in at least 56% of hospitals across the whole country, including all four Major Trauma Centres in the London network.
The data on its use and results is staggering; over 4,000 patients in one London hospital alone have been managed using the Score, leading to improved quality of care, better access to analgesia, as well as a reduced risk of developing complications.
A physiotherapy pathway based on the Score has also been implemented locally in Morriston Hospital, Wales, leading to the average length of stay in hospital falling by two days, and incredibly, in-hospital mortality dropping from 4% to 0% during the data collection period.
International Implementation
The use of the STUMBL Score is spreading widely, with an increasing number of purposes, that are crossing international borders. The Score is now recommended for use in national guidelines in countries including Ireland, New Zealand, Netherlands, Spain and the USA. Two particularly impactful examples of this can be found in Melbourne and Cork.
The Score is now used to guide physiotherapy management in Melbourne, Australia. High-risk older frail patients are targeted to receive intensive treatment, based on their score, which has resulted in increased rates of discharge for patients who can be managed safely in the comfort of their own home.
Pain management interventions are also guided by the Score in Cork University Hospital, who introduced the Score as part of their Chest Trauma Treatment Pathway. This led to patients receiving pain relief within 12 hours of admission on average (falling from 43), and a reduction in average length of hospital stay from 9 to 4 days.
On The Frontline
In Ukraine, the STUMBL Score is also used to manage patients in six frontline hospitals, treating those with penetrating chest wounds, resulting from blast-related injuries.
As a result of working directly with Professor Battle to implement the Score, Vinnitsia National Medical University Hospital now reports that over 200 conflict-injured patients per year have been managed using the Score since 2022, leading to a decrease in the average time, from triage to a decision being made regarding patient management, from 54 to 38 minutes.
Rates of admission have also fallen from 35% to 18% following its implementation; leading to a reduction in the demand being put on increasingly limited frontline resources, less unnecessary hospital visits for patients, and a vastly reduced number of individuals developing complications related to their original injury.
Professor Battle has even been in-country during the conflict in Ukraine, delivering guidance on the management of chest injuries using the Score at a national conference, and has also delivered similar online teaching to physiotherapists across Gaza.
The Future Of Blunt Chest Trauma Treatment
The use of the Score is spreading further still, with the hope that it can be extended to pre-hospital use; meaning that Paramedics will also implement the Score with patients at first contact in emergency healthcare settings, as well as it still being used in ED.
Professor Battle is currently developing this hand-in-hand with the Welsh Ambulance Service Trust (WAST), with the hope that this can be rolled out even wider as soon as possible, further improving patient care and outcomes across the country.
