The Quality of the Evidence in Craniomaxillofacial Trauma: Are We Making Progress?

Abstract

The purpose of this study is to evaluate the level of evidence in the craniomaxillofacial trauma literature. The secondary purpose is to determine if improvement in the quality of evidence has been made over the past 2 decades. This retrospective cohort study analyzed clinical articles published in select craniomaxillofacial surgery journals. Patient-focused articles were selected. The year of publication (1999, 2009, 2019) was the primary predictor variable. Secondary predictor variables included study funding status, anatomical facial region (eg maxilla, mandible, and so on), specific journal, and journal impact factor. The level of evidence was determined using the Center of Evidence-Based Medicine criteria, which served as the outcome variable. The statistical analysis included descriptive, bivariate, and regression analysis. The sample consisted of 469 craniomaxillofacial trauma articles, with 13.2% being published in 1999, 44.1% in 2009, and 42.6% in 2019. The majority of the studies (77.5%) were published in 4 journals. The impact factor varied among the journals with a significant improvement in the mean impact factor from (0.89 ± 0.29) in 1999 to (1.4 ± 0.47) in 2009 and a slight decline in 2019 (1.26 ± 0.71). Mandibular fractures (31.6%) and orbital trauma (26%) were the most investigated topics. Level 4 studies accounted for 67.4% of the sample, with level 3 evidence of 4.7%, level 2 of 22.6%, and level 1 of 5.3% of the included studies. Significant progress in the level of evidence has been made from 1999 but not since that time (P=.002). It is unclear why this may be but sheds light on the need for further development of high quality studies. Finally, a higher quality of evidence is associated with journal impact factor (odds ratio=1.9; P<.01) and funded research (odds ratio=4.69; P=.02). While there has been some improvement in the level of evidence in the craniomaxillofacial trauma literature over the past 2 decades, the current quality remains low, and further progress is needed to support the practice of evidence-based medicine.