Ryan Whitesell MD, Presenter: Nothing to Disclose

Scott David Steenburg MD, Abstract Co-Author: Nothing to Disclose

Changyu Shen PhD, Abstract Co-Author: Nothing to Disclose

Hongbo Lin MS, Abstract Co-Author: Nothing to Disclose

To identify the incidence and clinical predictors of facial fracture in the setting of whole-body multi-detector computed tomography (MDCT) for trauma.

500 consecutive patients who received dedicated maxillofacial CT as part of whole-body MDCT for trauma were studied. Patients younger than 18 and those who received initial evaluation at an outside facility were excluded. Fracture incidence and clinical parameters were obtained from the electronic medical record. Clinical and demographic variables were compared between patients who had an acute fracture and those who did not. Two sample t-tests were used to compare continuous variables, and the Fisher’s exact tests were used to compare categorical variables.

A total of 221 (44.2%) patients had acute fracture demonstrated on the maxillofacial CT. In all, 470 (94.0%) patients had documented positive facial physical exam findings at presentation. Of the 30 patients without exam findings, 29 (negative predictive value = 96.7%) did not have a facial fracture. Orbital fractures were most common overall, seen in 52.5% of positive cases. Nasal fractures were the most common isolated fracture (18.6% of all fractures; 42.3% of isolated fractures). Statistically significant difference was found between positive and negative cases of facial fracture in GCS score ≤ 8 (p <0.0001), intubated at presentation (p<0.0001), Injury Severity Score (ISS) of ≥ 16 (p<0.0001), positive facial physical exam (p<0.0001), and loss of consciousness (p = 0.0299). By history, the highest fracture rates were seen in falls from elevation or standing height and open-vehicle accidents (80.0%, 58.9%, and 55.2%, respectively). 

The absence of physical exam findings reliably excludes facial fractures. Clinical variables that positively associate with facial fracture include: GCS ≤ 8, ISS ≥ 16, intubated status, positive loss of consciousness, and presence of facial physical exam findings. 

These data can support clinical decision-making by identifying those at greatest risk for facial fracture and those who are less likely to have a fracture based on the initial clinical survey.

Whitesell, R, Steenburg, S, Shen, C, Lin, H, Facial Fracture in the Setting of Whole Body Computed Tomography for Trauma: Incidence and Clinical Predictors.  Radiological Society of North America 2014 Scientific Assembly and Annual Meeting, - ,Chicago IL. http://archive.rsna.org/2014/14004502.html