Thomas J Sitzman MD, Abstract Co-Author: Nothing to Disclose

Summer E Hanson MD, Abstract Co-Author: Nothing to Disclose

Nila H. Alsheik MD, Presenter: Nothing to Disclose

Lindell R. Gentry MD, Abstract Co-Author: Nothing to Disclose

John F. Doyle DDS, Abstract Co-Author: Nothing to Disclose

Karol A Gutowski MD, Abstract Co-Author: Nothing to Disclose

The aim of this poster is to present a simple set of clinical criteria to identify patients at high risk of facial fracture following trauma.  Ideal criteria should identify patients who are at high risk for fracture that need CT imaging while excluding those that are at low risk of injury who are unlikely to benefit from imaging.

A retrospective review of all patients with facial trauma who presented to the emergency department (ED) was conducted over a 3-year period.  Inclusion criteria required clinical evaluation by a trauma surgeon at the time of injury and subsequent multidetector CT imaging of the face and mandible.  The medical record was reviewed for numerous clinical findings on ED presentation that might potentially indicate facial fractures.  Neuroradiologist and plastic surgeons jointly reviewed all maxillofacial CT scans to identify and characterize all facial fractures and to access the clinical significance of facial injuries.  Patients with only skull base, skull vault, or temporal bone fractures were excluded as well as those with clinically insignificant isolated nasal arch and posterior maxillary sinus wall fractures.

525 patients met inclusion criteria. 332 (63.2%) of patients were diagnosed with a facial fracture. Logistic regression and regression tree analysis identified 4 simple high-risk clinical criteria that could potentially reduce maxillofacial CT utilization at our institution by 9.9%. These 4 clinical criteria included; bony stepoff or instability, malocclusion, periorbital swelling or contusion, and a Glasgow Coma Scale score of < 14. Only 1.5% (n=8) of low-risk patients were found to have a fracture on CT and only one of these patients required operative intervention. Excluding non-operative fractures, the negative predictive rate exceeds 98.0%

The use of 4 simple clinical criteria can reduce the utilization of maxillofacial CT at our institution by 9.9%. These criteria can identify patients at high risk of significant facial fractures who need CT imaging while safely excluding patients who will not benefit from CT imaging.

Four simple clinical criteria (bony stepoff/instability, malocclusion, periorbital swelling/contusion, and a GCS score of < 14) can be used to reduce the utilization of maxilofacial CT by 9.9%

Sitzman, T, Hanson, S, Alsheik, N, Gentry, L, Doyle, J, Gutowski, K, A Simple Set of Clinical Criteria to Screen for Maxillofacial Trauma.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8011256.html