A retrospective validation study of the STUMBL score for emergency department patients with blunt thoracic trauma.

INTRODUCTION: Blunt thoracic trauma (BTT) is a leading cause of emergency department (ED) trauma-related attendance. Risk prediction tools are commonly to predict patients' outcomes and assign them to the most appropriate care setting. The STUMBL score is a prognostic model for BTT, derived and validated in the United Kingdom; items comprising the score are age, number of rib fractures, use of pre-injury anticoagulants, chronic lung disease and oxygen saturation levels. This study's aim was to validate the STUMBL score in an Italian ED. METHODS: This single-centre retrospective validation study was conducted in the ED of Santa Croce and Carle hub hospital in Cuneo, north-western Italy. All patients with an ED attendance for isolated BTT from 2018 to 2021 were included. Exclusion criteria were an age of under eighteen and the presence of any immediately life-threatening lesion. The primary outcome was the development of trauma-related complications, defined by the occurrence of one or more of the following: in-hospital mortality, pulmonary complications (infection, pleural effusion, haemothorax, pneumothorax, pleural empyema), need for intensive care unit admission, hospital length of stay equal to or greater than seven days. The performance of the STUMBL score was analysed in terms of discrimination with the evaluation of the receiver operating characteristic curve and calibration with the Hosmer-Lemeshow test and with the calibration belt. RESULTS: 745 patients were enroled (median age 64 [25th;75th percentile: 50;78], male/female ratio 1:4, median Charlson comorbidity index 2 [1;4], median STUMBL score 11 [6;17]). 65.2% of patients were discharged home after ED evaluation. 203 patients (27.2%) developed the primary outcome. The STUMBL score was significantly different in patients with complications compared to those without complications (9 [5;13] vs 21 [17;25], p < 0.001). The C index of the score for the primary outcome was 0.90 (95% CI 0.88-0.93), and the result of the Hosmer-Lemeshow test was 9.01 (p = 0.34). STUMBL score = 16 has a sensitivity of 0.80 (95% CI 0.75-0.85), specificity of 0.87 (95% CI 0.84-0.90), a positive predictive value of 0.70 (95% CI 0.64-0.76), and a negative predictive value of 0.92 (95% CI 0.90-0.94). CONCLUSION: In this validation study, the STUMBL score demonstrated excellent discrimination and calibration in predicting the outcome of patients attending the ED with a BTT.

Epidemiology of burns and scalds in children presenting to the emergency department of a regional burns unit: a 7-year retrospective study.

BACKGROUND: Variation in the incidence and mechanism of thermal injury has been reported in different age groups in children. The aim of this study was to report the incidence, mechanisms, and environmental factors of all burns presentations to the emergency department (ED) of a regional burns centre over a 7-year period. METHODS: A retrospective, chart review study of all burns presentations to the ED of a regional burns centre in South Wales was conducted. All children recorded as having sustained a burn or scald, aged less than 16 years were included in the analysis. Subjects' demographics were analysed using descriptive statistics, and comparisons were made between patients aged less than 5 and patients aged 5-16 using chi-square test and Mann-Whitney U test. RESULTS: A total of 1387 cases were included in the final analysis. Scalds were the most common thermal injury with 569 (41.0 %) reported, followed by contact burns in 563 (40.6 %) patients. The patients requiring hospitalisation were significantly younger (2 vs 3 years; p < 0.001) and had a higher rate of non-accidental injury (10 vs 4; p < 0.001). The most commonly injured site in both age groups was a hand or digit. CONCLUSIONS: Scalds and contact burns were the most commonly reported thermal injury in children aged less than 16. Common mechanisms were hot beverages, hobs and hair straighteners, highlighting further burn prevention strategies are needed and good-quality prospective studies that investigate the effectiveness of such strategies.

Cognitive Outcomes following Thrombolysis in Acute Ischemic Stroke: A Systematic Review.

BACKGROUND: Patients treated with thrombolytic therapy within 4.5 hours after stroke onset appear to have improved survival and functional outcomes. Poststroke cognitive impairment is associated with reduced quality of life and survival and needs to be reviewed in consideration of the administration of thrombolysis. This review aims to systematically evaluate literature exploring the effect of thrombolysis for ischemic stroke on cognition. METHODS: An electronic search was conducted to identify articles and gray literature applying broad Medical Subject Heading terms. Literature was reviewed with a 2-step process against predetermined inclusion criteria. All relevant studies were included if they investigated global or individual cognitive domains. RESULTS: Three studies satisfied the inclusion criteria but were diverse in outcome measures and duration, their heterogeneity limiting any possible pooled analysis. One study examined long-term treatment effects on global cognition and did not find a positive effect at 6 months. A positive treatment effect was reported in the acute phase in 1 study examining domains of visuoconstructive and perceptive abilities. One study retrospectively analyzed treatment effects on language and found improvement in the acute phase but not in the long term. CONCLUSIONS: The limited existing evidence on the effects of thrombolytic therapy on long- and short-term cognition is varied in both outcome measures and diagnostic classifications, making it difficult to extrapolate results to a global stroke population. This review should be used to inform future research in stroke treatment outcomes and highlights the immediate need for larger, more robust studies in this area.

The risk factors for the development of complications during the recovery phase following blunt chest wall trauma: a retrospective study.

STUDY OBJECTIVE: The difficulties in the management of the blunt chest wall trauma patient in the Emergency Department (ED) due to the development of late complications are well recognised in the literature. The aim of this study was to investigate the risk factors for the development of complications in the recovery phase following blunt chest wall trauma. METHODS: A retrospective study was completed in which the medical notes were analysed of all blunt chest wall trauma patients presenting to a large trauma centre in South Wales in 2009 and 2010. Using univariate and multivariable logistic regression analysis, the risk factors for development of complications during the recovery phase following blunt chest wall trauma were investigated. RESULTS: Risk factors for development of complications in the recovery phase following blunt chest wall trauma in the univariate analysis were a patient age of 65 years or more, three or more rib fractures, presence of chronic lung disease or cardiovascular disease, pre-injury anticoagulant use and blood oxygen saturation levels of less than 90%. On multivariable analysis, the risk factors were three or more rib fractures, chronic lung disease, pre-injury anticoagulant use and oxygen saturations of less than 90%. CONCLUSION: A number of risk factors have been presented in this study which should be considered in the management of the blunt chest wall trauma patient. This is the first study in which a number of the risk factors have been investigated and this may provide the basis for further prospective studies.

Expert opinion of the risk factors for morbidity and mortality in blunt chest wall trauma: results of a national postal questionnaire survey of Emergency Departments in the United Kingdom.

OBJECTIVE: Blunt chest wall trauma is a common injury treated in the Emergency Departments and has a high reported morbidity and mortality. No national guidelines exist for the management of this patient group unless the patient has severe immediate life-threatening injuries. The aim of this study was to investigate current management of blunt chest wall trauma patients in the UK and to gather expert opinion of the risk factors for morbidity and mortality. METHODOLOGY: A sample of 100 physicians working in Emergency Departments in the UK were purposively selected and sent a postal questionnaire to complete. Non-responder analysis was undertaken in order to assess bias. The completed questionnaires were analysed with descriptive statistics. RESULTS: A response rate of 90% was achieved. The different type of hospital providing emergency care was well represented in the results. The general surgical team was the most frequently used ward-based team when the patient required admission to hospital (51%). Inconsistencies exist regarding the use of guidelines for the management of the blunt chest wall patient. The risk factors for morbidity and mortality suggested by the sample concurred with current literature including patient age, pre-existing conditions and number of ribs fractured and areas for further research were highlighted. CONCLUSION: Variation exists in the management of blunt chest wall trauma patients in the UK. This study provides the expert opinion of a sample of 90 physicians working in Emergency Departments in the UK regarding the risk factors for morbidity and mortality in blunt chest wall trauma patients.