Combining trauma severity indices to create a unified craniofacial disruption index: addition of the frontobasal unit to the ZS model.

Abstract

Craniomaxillofacial injuries account for a large number of emergency attendances and a substantial proportion of the workload of acute clinicians. Although data exist on frequency of involvement of the craniofacial bones, assessments of severity are lacking, and scoring systems for fractures of individual bones and complex craniomaxillofacial trauma often fail to include the frontobasal unit. To rectify this, we have devised a validated scoring system to evaluate the severity of trauma to this region and have merged it with a pre-existing model to create a cohesive craniofacial disruption index. Published papers were reviewed and the frontobasal unit defined. Clinically important anatomical regions were assigned a graduated score that depended on the severity of disruption, and this was applied in the cases of 13 patients with known craniofacial fractures of varying severity. Correlation with existing models was calculated and used as a marker of validity. Our frontobasal system showed strong positive correlation with a consensus of OMFS clinicians (r=0.783, p<0.01). When amalgamated with the pre-existing ZS score to create the Craniofacial Disruption Index, it correlated strongly with all previous scoring systems (r≥0.729, p<0.001). The index is a user-friendly, validated model that enables comparison of the severity of complex craniofacial injuries. It has many potential uses because of its digital, automated method of calculation.