Facial Trauma Coverage Among Level-1 Trauma Centers of the United States

Abstract

A large portion of patients admitted to trauma centers present with isolated or concomitant facial injuries. Multiple surgical specialties including oral and maxillofacial, plastic, and otolaryngology/head and neck surgeons are trained and involved in the management of oral and maxillofacial trauma. The purpose of this study is to evaluate the current distribution of different specialties that cover facial trauma among the leading trauma centers in the United States. Based on the number of emergency department admissions, the 5 busiest hospitals for each state within the United States were determined from the American Hospital Association, representing a total of 255 hospital emergency rooms. Seventy-six (N = 76) level-1 trauma centers were identified by directly contacting the hospital facility. Information was requested by mail from the chief of surgery and emergency medicine department regarding the percentage of facial trauma coverage by the different surgical specialties. In addition, the professional societies representing the 3 main specialties: American Association of Oral and Maxillofacial Surgeons (AAOMS), American Association of Plastic Surgeons (AAPS), and the American Academy of Otolaryngologists/Head and Neck Surgeons (AAO-HNS) were contacted to determine an estimate of the number of active members within each specialty. Information was obtained from 57 (75%) level-1 trauma hospitals. The remaining 19 (25%) hospitals failed to respond to our survey. The distribution of facial trauma coverage by the different specialties was as follows: plastic surgeons, 39.6%; oral and maxillofacial surgeons, 36.6%; otolaryngologists/head and neck surgeons, 23.3%; and other services (general surgery and oculoplastics), 0.5%. According to the respective professional societies contacted, there are approximately 7,003 plastic surgeons, 6,377 oral and maxillofacial surgeons, and 7,720 head and neck surgeons that are practicing members of their respective societies. Treatment of facial trauma is an essential and demanding aspect of all the surgical specialties that provide this service. All major trauma centers require the support of facial trauma specialists for management of these injuries. When considering the ratio of surgeons per specialty and the percentage of facial trauma coverage provided by each specialty, oral and maxillofacial surgeons and plastic surgeons provide the greatest proportion of facial trauma coverage among the level-1 trauma centers that participated in the survey.