Facial fracture in the setting of whole-body CT for trauma: Incidence and clinical predictors

Ryan T. Whitesell, Scott Steenburg, Changyu Shen, Hongbo Lin

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

OBJECTIVE. The objective of our study was to identify the incidence and clinical predictors of facial fracture in the setting of whole-body MDCT for trauma. MATERIALS AND METHODS. The clinical data from the electronic medical records, including the final radiology reports, of 486 consecutive patients who underwent MDCT for trauma (head, cervical spine, chest, abdomen, and pelvis examinations) with dedicated maxillofacial reconstructions from October 1, 2011, to July 31, 2013, were studied. The clinical variables were compared between cohorts of patients with and those without facial fracture. The two-sample t test was used to compare continuous variables, and the Fisher exact test was used to compare categoric variables. RESULTS. Two hundred sixteen (44.4%) patients had at least one fracture on the dedicated maxillofacial CT examinations, 215 of whom had facial physical examination findings (sensitivity = 99.5%). Of the 28 patients without documented physical examination findings, 27 did not have a facial fracture (negative predictive value = 96.4%). Statistically significant differences were found between positive and negative cases of facial fracture in patients with a Glasgow coma scale (GCS) score of 8 or less (p <0.0001), an injury severity score of 16 or greater (p <0.0001), acute alcohol intoxication according to blood alcohol concentration (BAC) (p = 0.0387), intubation at presentation (p <0.0001), positive physical examination findings (p <0.0001), and loss of consciousness (p = 0.0364). Falls from a height greater than standing height and open-vehicle collisions had the highest fracture rates (80.0% and 58.3%, respectively). CONCLUSION. A negative finding at facial physical examination reliably excluded fracture. Clinical variables positively associated with facial fracture included the following: GCS score of 8 or less, ISS of 16 or greater, alcohol intoxication according to BAC, intubation at presentation, loss of consciousness, and the presence of abnormal facial findings at physical examination.

Original languageEnglish (US)
Pages (from-to)W4-W10
JournalAmerican Journal of Roentgenology
Volume205
Issue number1
DOIs
StatePublished - Jul 1 2015

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Physical Examination
Incidence
Wounds and Injuries
Alcoholic Intoxication
Glasgow Coma Scale
Unconsciousness
Intubation
Injury Severity Score
Electronic Health Records
Pelvis
Craniocerebral Trauma
Radiology
Abdomen
Spine
Thorax
Blood Alcohol Content

Keywords

  • Emergency
  • Maxillofacial
  • MDCT
  • Trauma

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

Cite this

Facial fracture in the setting of whole-body CT for trauma : Incidence and clinical predictors. / Whitesell, Ryan T.; Steenburg, Scott; Shen, Changyu; Lin, Hongbo.

In: American Journal of Roentgenology, Vol. 205, No. 1, 01.07.2015, p. W4-W10.

Research output: Contribution to journalArticle

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abstract = "OBJECTIVE. The objective of our study was to identify the incidence and clinical predictors of facial fracture in the setting of whole-body MDCT for trauma. MATERIALS AND METHODS. The clinical data from the electronic medical records, including the final radiology reports, of 486 consecutive patients who underwent MDCT for trauma (head, cervical spine, chest, abdomen, and pelvis examinations) with dedicated maxillofacial reconstructions from October 1, 2011, to July 31, 2013, were studied. The clinical variables were compared between cohorts of patients with and those without facial fracture. The two-sample t test was used to compare continuous variables, and the Fisher exact test was used to compare categoric variables. RESULTS. Two hundred sixteen (44.4{\%}) patients had at least one fracture on the dedicated maxillofacial CT examinations, 215 of whom had facial physical examination findings (sensitivity = 99.5{\%}). Of the 28 patients without documented physical examination findings, 27 did not have a facial fracture (negative predictive value = 96.4{\%}). Statistically significant differences were found between positive and negative cases of facial fracture in patients with a Glasgow coma scale (GCS) score of 8 or less (p <0.0001), an injury severity score of 16 or greater (p <0.0001), acute alcohol intoxication according to blood alcohol concentration (BAC) (p = 0.0387), intubation at presentation (p <0.0001), positive physical examination findings (p <0.0001), and loss of consciousness (p = 0.0364). Falls from a height greater than standing height and open-vehicle collisions had the highest fracture rates (80.0{\%} and 58.3{\%}, respectively). CONCLUSION. A negative finding at facial physical examination reliably excluded fracture. Clinical variables positively associated with facial fracture included the following: GCS score of 8 or less, ISS of 16 or greater, alcohol intoxication according to BAC, intubation at presentation, loss of consciousness, and the presence of abnormal facial findings at physical examination.",
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N2 - OBJECTIVE. The objective of our study was to identify the incidence and clinical predictors of facial fracture in the setting of whole-body MDCT for trauma. MATERIALS AND METHODS. The clinical data from the electronic medical records, including the final radiology reports, of 486 consecutive patients who underwent MDCT for trauma (head, cervical spine, chest, abdomen, and pelvis examinations) with dedicated maxillofacial reconstructions from October 1, 2011, to July 31, 2013, were studied. The clinical variables were compared between cohorts of patients with and those without facial fracture. The two-sample t test was used to compare continuous variables, and the Fisher exact test was used to compare categoric variables. RESULTS. Two hundred sixteen (44.4%) patients had at least one fracture on the dedicated maxillofacial CT examinations, 215 of whom had facial physical examination findings (sensitivity = 99.5%). Of the 28 patients without documented physical examination findings, 27 did not have a facial fracture (negative predictive value = 96.4%). Statistically significant differences were found between positive and negative cases of facial fracture in patients with a Glasgow coma scale (GCS) score of 8 or less (p <0.0001), an injury severity score of 16 or greater (p <0.0001), acute alcohol intoxication according to blood alcohol concentration (BAC) (p = 0.0387), intubation at presentation (p <0.0001), positive physical examination findings (p <0.0001), and loss of consciousness (p = 0.0364). Falls from a height greater than standing height and open-vehicle collisions had the highest fracture rates (80.0% and 58.3%, respectively). CONCLUSION. A negative finding at facial physical examination reliably excluded fracture. Clinical variables positively associated with facial fracture included the following: GCS score of 8 or less, ISS of 16 or greater, alcohol intoxication according to BAC, intubation at presentation, loss of consciousness, and the presence of abnormal facial findings at physical examination.

AB - OBJECTIVE. The objective of our study was to identify the incidence and clinical predictors of facial fracture in the setting of whole-body MDCT for trauma. MATERIALS AND METHODS. The clinical data from the electronic medical records, including the final radiology reports, of 486 consecutive patients who underwent MDCT for trauma (head, cervical spine, chest, abdomen, and pelvis examinations) with dedicated maxillofacial reconstructions from October 1, 2011, to July 31, 2013, were studied. The clinical variables were compared between cohorts of patients with and those without facial fracture. The two-sample t test was used to compare continuous variables, and the Fisher exact test was used to compare categoric variables. RESULTS. Two hundred sixteen (44.4%) patients had at least one fracture on the dedicated maxillofacial CT examinations, 215 of whom had facial physical examination findings (sensitivity = 99.5%). Of the 28 patients without documented physical examination findings, 27 did not have a facial fracture (negative predictive value = 96.4%). Statistically significant differences were found between positive and negative cases of facial fracture in patients with a Glasgow coma scale (GCS) score of 8 or less (p <0.0001), an injury severity score of 16 or greater (p <0.0001), acute alcohol intoxication according to blood alcohol concentration (BAC) (p = 0.0387), intubation at presentation (p <0.0001), positive physical examination findings (p <0.0001), and loss of consciousness (p = 0.0364). Falls from a height greater than standing height and open-vehicle collisions had the highest fracture rates (80.0% and 58.3%, respectively). CONCLUSION. A negative finding at facial physical examination reliably excluded fracture. Clinical variables positively associated with facial fracture included the following: GCS score of 8 or less, ISS of 16 or greater, alcohol intoxication according to BAC, intubation at presentation, loss of consciousness, and the presence of abnormal facial findings at physical examination.

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