Have Incidence and Severity of Craniomaxillofacial Fractures Changed Since SARS-CoV-2?

Abstract

An increase in severity and a decrease in incidence of craniomaxillofacial fractures (CMFs) were identified during the first several months of the SARS-CoV-2 pandemic. It is unclear if these changes have persisted in the current timeframe. The investigators hypothesize that the incidence and severity of CMF will not return to baseline prepandemic (control) levels as the pandemic stabilizes and becomes endemic. This retrospective cohort study enrolled subjects who presented to Harborview Medical Center a Level 1 trauma center for the evaluation and management of CMF. Inclusion criteria were 1) Presentation timeline 2018 through 2022, 2) CMF identified by the 10th International Classification of Disease. Exclusion criteria were: 1) Undocumented etiology of facial fracture and 2) inadequate/unclear documentation otherwise. The predictor variable was year of injury relating to the start of the pandemic. The groups were the prepandemic (2018, 2019) and postpandemic (2020, 2021. 2022). The primary outcome variable was the CMF diagnosis identified using the corresponding International Classification of Disease, 10th Edition codes. The secondary outcome variables were mechanism of injury and injury severity. The covariates were age, sex, race/ethnicity, admission status, alcohol intoxication, toxicology screen, reimbursement source, abuse reported, and abuse investigated. Univariate and bivariate analyses were performed with statistical significance at P<.05. The sample was composed of 5203 subjects. The annual volumes of subjects presenting with CMF were consistent over the study period (2018, 2019, 2020, 2021, 2022 n=1018, 963, 1020, 1062, 1140, respectively). The incidence of Hispanics increased (2018, 2019, 2020, 2021, 2022: 11.1, 9.6, 12.2, 13.9, 13.2% (P<.05)) as did firearm CMF injuries (2018, 2019, 2020, 2021, 2022: 4.13, 4.98, 4.71, 7.16, 6.75% (P<.05)). The Injury Severity Score and Abbreviated Injury Scale were both lower postpandemic compared to prepandemic; mean Injury Severity Score post [18.27±12.46] versus pre [19.25±12.89] (P<.05), mean Abbreviated Injury Scale post [2.94±1.15] versus pre [3.04±1.14] (P<.05). While the severity of CMF decreased postpandemic, Hispanic and firearm CMF increased. The overall CMF incidence remained the same. The significant rise in firearm injuries warrants further study.