S — Sedation/Analgesic Requirements (severity of pain/agitation requiring sedation)

Controlled with oral/IV analgesic as needed — no sedation needed (0 pts)+0Requires IV opioid infusion or scheduled IV agents (1 pt)+1Requires sedation for ventilator management or extreme agitation (2 pts)+2

T — Number of Transfers / Imaging Required (reflects injury complexity)

1–2 imaging studies — single trauma team involvement (0 pts)+03–4 imaging studies or subspecialty consultation required (1 pt)+1Multiple subspecialty emergencies + multiple OR trips anticipated (2 pts)+2

U — Urine Output (mL/kg/hr in first 4 hours)

Adequate: ≥ 0.5 mL/kg/hr (0 pts)+0Reduced: 0.3–0.5 mL/kg/hr (1 pt)+1Oliguria: < 0.3 mL/kg/hr (2 pts)+2

M — Mechanical Ventilation Requirement

Not intubated — maintaining own airway (0 pts)+0Supplemental O₂ or non-invasive positive pressure required (1 pt)+1Endotracheal intubation and mechanical ventilation (2 pts)+2

B — Blood Products in First 4 Hours

None required (0 pts)+01–3 units PRBC or equivalent products (1 pt)+1≥ 4 units PRBC — Massive transfusion protocol activated (2 pts)+2

L — Initial Serum Lactate

Normal: < 2.0 mmol/L (0 pts)+0Mildly elevated: 2.0–3.9 mmol/L (1 pt)+1Severely elevated: ≥ 4.0 mmol/L (2 pts)+2

STUMBL Score — Screening Tool for Unstable Malleolar Blast and Lower-extremity Injuries

STUMBL Score — Screening Tool for Unstable Malleolar Blast and Lower-extremity Injuries