A multicentre randomised feasibility STUdy evaluating the impact of a prognostic model for Management of BLunt chest wall trauma patients: STUMBL Trial

• Published in: BMJ open 2019-07, Vol.9 (7), p.e029187
• Main Authors: Battle, Ceri, Hutchings, Hayley A, Driscoll, Timothy, O’Neill, Claire, Groves, Sam, Watkins, Alan, Lecky, Fiona Elizabeth, Jones, Sally, Gagg, James, Body, Richard, Abbott, Zoe, Evans, Phillip A
• Format: Article
• Language: English
• Subjects: Adult; Aged; Clinical outcomes; Clinical trials; Cost-Benefit Analysis; Critical care; Data collection; Emergency medical care; Emergency Medicine; Emergency Service, Hospital; Feasibility Studies; Female; Focus groups; Humans; Male; Medical prognosis; Medical research; Middle Aged; Models, Statistical; Mortality; Nurses; Patients; Prognosis; Prospective Studies; Regression analysis; Thoracic Injuries - therapy; Trauma; trauma management; Treatment Outcome; Wounds, Nonpenetrating - therapy
• ISSN: 2044-6055; 2044-6055
• DOI: 10.1136/bmjopen-2019-029187

ObjectiveA new prognostic model has been developed and externally validated, the aim of which is to assist in the management of the blunt chest wall trauma patient in the emergency department (ED). The aim of this trial is to assess the feasibility and acceptability of a definitive impact trial investigating the clinical and cost-effectiveness of a new prognostic model for the management of patients with blunt chest wall trauma in the ED.DesignStepped wedge feasibility trial.SettingFour EDs in England and Wales.ParticipantsAdult blunt chest wall trauma patients presenting to the ED with no concurrent, life-threatening injuries.InterventionA prognostic model (the STUMBL score) to guide clinical decision-making.Outcome measuresPrimary: participant recruitment rate and clinicians’ use of the STUMBL score. Secondary: composite outcome measure (mortality, pulmonary complications, delayed upgrade in care, unplanned representations to the ED), physical and mental components of quality of life, clinician feedback and health economic data gathering methodology for healthcare resource utilisation.ResultsQuantitative data were analysed using the intention-to-treat principle. 176 patients were recruited; recruitment targets were achieved at all sites. Clinicians used the model in 96% of intervention cases. All feasibility criteria were fully or partially met. After adjusting for predefined covariates, there were no statistically significant differences between the control and intervention periods. Qualitative analysis highlighted that STUMBL was well-received and clinicians would support a definitive trial. Collecting data on intervention costs, health-related quality of life and healthcare resource use was feasible.DiscussionWe have demonstrated that a fully powered randomised clinical trial of the STUMBL score is feasible and desirable to clinicians. Minor methodological modifications will be made for the full trial.Trial registration number ISRCTN95571506; Post-results.