Improving Blunt Thoracic Trauma Prognosis: Validation of the Study of the Management of Blunt Chest Wall Trauma Score against Injury Severity Score in an Indonesian Tertiary Hospital.

Background Blunt thoracic trauma is a leading cause of trauma-related morbidity and mortality worldwide. Although the Injury Severity Score (ISS) is widely used to assess overall trauma severity, it lacks specificity for thoracic injuries. The Study of the Management of Blunt Chest Wall Trauma (STUMBL) score, which incorporates age, number of rib fractures, chronic lung disease, oxygen saturation, and pre-injury anticoagulant use, has not been validated in the Indonesian clinical setting.

Methods A prospective cohort study was conducted at Dr. Saiful Anwar General Hospital, Malang, Indonesia, between February 2024 and April 2025. Adult patients (≥18 years) with confirmed blunt thoracic trauma and a Glasgow Coma Scale score of 14-15 were included. Demographic, clinical, and radiologic variables were recorded, and ISS and STUMBL scores were calculated at admission. Outcomes included prolonged hospitalization (≥7 days), intensive care unit (ICU) admission, and in-hospital mortality. Statistical analyses included the Mann-Whitney U test and receiver operating characteristic curve analysis.

Results Among 371 patients, 75.7% were male, with a median age of 43 years. Road traffic accidents accounted for 69.5% of cases. ICU admission occurred in 18.3% of patients, and in-hospital mortality was 5.4%. Both ISS and STUMBL scores were significantly higher among patients with adverse outcomes (p<0.001 for all comparisons). The STUMBL score demonstrated superior predictive accuracy, with area under the curve (AUC) values of 0.896 for prolonged hospitalization, 0.894 for ICU admission, and 0.859 for in-hospital mortality. A cut-off >10.5 yielded sensitivities ranging from 70.0% to 74.1% and specificities ranging from 80.6% to 92.4%. In contrast, ISS demonstrated lower AUC values (0.753-0.802) and reduced discriminatory ability.

Conclusion The STUMBL score outperformed ISS in predicting prolonged hospitalization, ICU admission, and in-hospital mortality among patients with blunt thoracic trauma. Its application may improve early risk stratification and support clinical decision-making in Indonesian tertiary hospitals.