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Calculator · Blunt chest wall trauma — risk of complications
STUMBL / Battle score
UK-derived, in Cardiff, and the reason it is here is that rib fractures kill by what happens on day three, not on arrival. This is the score that says which apparently comfortable patient is going to develop a pneumonia.
What it asks
| Criterion | Points |
|---|---|
| Age One point per decade | Under 20 — 1 20 – 29 — 2 30 – 39 — 3 40 – 49 — 4 50 – 59 — 5 60 – 69 — 6 70 – 79 — 7 80 or over — 8 |
| Number of rib fractures Three points each | None seen — 0 1 — 3 2 — 6 3 — 9 4 — 12 5 or more — 15 |
| Pre-injury anticoagulant Warfarin or a DOAC. Antiplatelets alone do not score. | No — 0 Yes — 4 |
| Chronic lung disease | No — 0 Yes — 5 |
| Oxygen saturation on arrival | 95% or above — 0 90 – 94% — 2 85 – 89% — 5 80 – 84% — 8 Below 80% — 10 |
How to read the score
| Score | Means | What to do |
|---|---|---|
| 0–10 | Lower risk | Discharge may be appropriate with analgesia, a plan and safety-netting — including what breathlessness or fever on day 3 should make them do. |
| 11–25 | High risk of complications | Admit. The complications are pulmonary and they are largely preventable: regular analgesia, a block if the pain is not controlled, physiotherapy and incentive spirometry from day one. |
| 26–42 | Consider critical care | Discuss with critical care early. At this level the question is where they are nursed, not whether they are admitted. |
Before you use it
The score does not tell you the analgesia is adequate — you do, by asking them to take a deep breath and cough. Pain relief here is a RESPIRATORY intervention, not comfort, and the reason for a block is to prevent the pneumonia rather than to be kind. Also: this is a chest WALL score. It says nothing about the aorta, the diaphragm or the abdominal organs under the lower ribs, and a low score does not mean a low-energy mechanism.
Source: Battle et al, Emerg Med J 2014 (STUMBL)
Checked, and shown
Every threshold on this page was checked against its primary source by a practising doctor. Here is what that involved, and what it found.