Facial Trauma Patients Research Articles

Facial fractures at a tertiary health care facility vis a vis time of presentation: a pilot study

Background: Facial trauma patients were analyzed to determine the time of presentation at the trauma unit following, fractures of the naso-orbital and maxilla-mandibular region.Methods: This prospective study was conducted at Dayanand medical college and hospital, Ludhiana, Punjab, for a period of two years from January 2015 to June 2017. 61 patients admitted in the maxillofacial trauma unit were analyzed.Results: The males outnumbered the females in the ratio of 5: 1. The maximum numbers of patients 33 patients (54%) were seen in the age group 21-30 years and minimum at extremes of age. Vehicular trauma was the predominant etiology, noted in 44 cases (72.13%). Most of the patients, i.e., 85 cases (95.1%) of the fractures, were seen within 24 hours of sustaining trauma. Only 2 cases (2.4%) of fracture were admitted on the second day. The only case of orbital blow out fracture reported 41⁄2 months after injury.Conclusions: Most (93.4%) of the patients with facial fractures presented on the same day of injury. 2 cases of zygomatic fracture presented on the 2nd day and one on the 3rd day.

Pattern of associated brain injury in maxillofacial trauma: a retrospective study from a high-volume centre

The incidence of head injury in maxillofacial trauma patients varies widely in the literature. A good understanding of the patterns of association between these injuries would aid in efficient multidisciplinary treatment. The aim of this study therefore was to understand the associations between head injury and facial trauma by retrospectively analysing the records of patients seen at a tertiary care trauma centre. Demographic data were also described. Records of 4350 facial trauma patients over a five-year period were reviewed. A total of 3564 (81.9%) patients were victims of motor vehicle accidents (MVA). Male patients predominated, comprising 3711 (85.3%), and 36.6% were in the third decade of life. Facial fractures were seen in 2120 (48.7%), the most common being zygomatic fractures (60%). At the time of trauma, 2383 (57.3%) patients were under the influence of alcohol, and 2821 (87.8%) victims of two-wheeler MVAs were not using their helmet. Of all patients, 29.75% sustained a traumatic brain injury (TBI). Midface fractures were strongly associated with TBI. Maxillofacial injury may be considered a risk factor for TBI, and as such should immediately be suspected and investigated in all patients. Prompt recognition and management can improve outcomes in these patients.

Effectiveness of Cognitive Behavior Therapy Combined with Eye Movement Desensitization and Reprocessing on Psychological Problems and Life Quality in Patients' Postfacial Trauma.

Objective To investigate the effectiveness of cognitive behavior therapy (CBT) combined with eye movement desensitization and reprocessing (EMDR) on the esteem, anxiety, depression, posttrauma stress disorder (PTSD), and posttraumatic growth in patients with facial trauma. Methods A total of 92 facial trauma patients in Wenzhou People's Hospital from January 2017 to December 2019 were enrolled in this study. The patients were randomly divided into control group (n = 46) and intervention group (n = 46). Both of the control group and the intervention group received routine treatment, while the intervention group further received CBT combined with EMDR. Questionnaires were used to explore and record the general patient information. The Self-Esteem Scale (SES), Self-Anxiety Scale (SAS), Self-Depression Scale (SDS), Posttraumatic Stress Disorder Checklist Civilian Version (PCL-C), Posttraumatic Growth Inventory (PTGI), and World Health Organization Quality of Life-brief (WHOQOL-BREF) scores between the two groups were compared. Results After CBT combined with EMDR intervention, the SDS and SAS scores in the intervention group were significantly decreased compared with the scores before intervention with statistically significance (P < 0.001). Furthermore, the PCL-C score in the intervention group showed significant decrease in comparison with the control group (P < 0.001), while the PTGI score in the intervention group was significantly higher than the control group (P < 0.001). The WHOQOL-BREF scores were increased after treatment in the two groups compared with the scores before treatment, and the scores in the intervention group were higher than those in the control group after treatment (P < 0.01). Conclusion Psychological intervention therapy can effectively alleviate the anxiety, depression, and PTSD and improve the life quality and the recovery of facial trauma patients.

Interfacility Transfer Guidelines for Isolated Facial Trauma: A Multidisciplinary Expert Consensus.

The objective of this study was to develop guidelines for the transfer of patients with isolated craniomaxillofacial trauma. A national, multidisciplinary expert panel was assembled from leadership in national organizations and contributors to published literature on facial reconstruction. The final panel consisted of five plastic surgeons, four otolaryngologist-head and neck surgeons, and four oral and maxillofacial surgeons. The expert panelists' opinions on transfer guidelines were collected using the modified Delphi process. Consensus was predefined as 90 percent or greater agreement per statement. After four Delphi consensus building rounds, 13 transfer guidelines were established, including statements on fractures of the frontal sinus, orbit, midface, and mandible, as well as soft-tissue injuries. Twelve guidelines reached consensus. The decision to transfer a patient with craniomaxillofacial trauma to another facility is complex and multifactorial. While a percentage of overtriage is acceptable to promote safe disposition of trauma patients, unnecessarily high rates of secondary overtriage divert emergency medical services, increase costs, delay care, overload tertiary trauma centers, and result in tertiary hospital staff providing primary emergency coverage for referring hospitals. These craniomaxillofacial transfer guidelines were designed to serve as a tool to improve and streamline the care of facial trauma patients. Such efforts may decrease the additional health care expenditures associated with secondary overtriage while decompressing emergency medical systems and tertiary emergency departments.

Trends in Pediatric Head and Facial Trauma During the COVID-19 Pandemic.

The effect of physical-distancing policies and school closures on pediatric health has been a topic of major concern in the United States during the coronavirus disease 2019 (COVID-19) pandemic. The objective of this study was to assess the immediate impact of these public policies on patterns of head and facial trauma in the pediatric population. The Pediatric Health Information System (PHIS) was queried to identify patient encounters at 46 children's hospitals across the United States in 2016-2020. Encounters were included if resultant in ICD-10 diagnosis for head or facial trauma in a child under 18 between April 1 and June 30 in 2020 (first COVID-19 school closures) and during the same period in the previous 4 years (for comparison). A total of 170,832 patient encounters for pediatric head and facial trauma were recorded during the study period, including 28,030 (16.4%) in 2020 and 142,802 (83.6%) in 2016-2019. Patient encounters declined significantly in 2020 among children of all age groups relative to previous years. Relative reductions were greatest in children aged 11 to 17 (middle/high school) and 6 to 10 (elementary school), at -34.6% (95% confidence interval: -23.6%, -44%; P <0.001) and -27.7% (95% confidence interval: -18.4%, -36%; P <0.001). Variation in relative reductions by race/ethnicity, sex, and rural/urban status were not statistically significant. Physical-distancing policies and school closures at the start of the COVID-19 pandemic correlated with significant reductions in pediatric head and facial trauma patient encounters. As in-person activities resume, reductions in head and facial trauma during the pandemic may indicate a range of possible preventable injuries in the future.

“A” stands for airway – Which factors guide the need for on-scene airway management in facial fracture patients?

BackgroundNumerous guidelines highlight the need for early airway management in facial trauma patients since specific fracture patterns may induce airway obstruction. However, the incidence of these hallmark injuries, including flail mandibles and posterior displacement of the maxilla, is contentious. We aim to evaluate specific trauma-related variables in facial fracture patients, which affect the need for on-scene versus in-hospital airway management.MethodsThis retrospective cohort study included all patients with any type of facial fracture, who required early airway management on-scene or in-hospital. The primary outcome variable was the site of airway management (on-scene versus hospital) and the main predictor variable was the presence of a traumatic brain injury (TBI). The association of fracture type, mechanism, and method for early airway management are also reported. Altogether 171 patients fulfilled the inclusion criteria.ResultsOf the 171 patients included in the analysis, 100 (58.5) had combined midfacial fractures or combination fractures of facial thirds. Altogether 118 patients (69.0%) required airway management on-scene and for the remaining 53 patients (31.0%) airway was secured in-hospital. A total of 168 (98.2%) underwent endotracheal intubation, whereas three patients (1.8%) received surgical airway management. TBIs occurred in 138 patients (80.7%), but presence of TBI did not affect the site of airway management. Younger age, Glasgow Coma Scale-score of eight or less, and oro-naso-pharyngeal haemorrhage predicted airway management on-scene, whereas patients who had fallen at ground level and in patients with facial fractures but no associated injuries, the airway was significantly more often managed in-hospital.ConclusionsProper preparedness for airway management in facial fracture patients is crucial both on-scene and in-hospital. Facial fracture patients need proper evaluation of airway management even when TBI is not present.

Evaluation of the outcomes of using iliac bone graft for reconstruction of traumatic orbital floor fractures.

Orbital floor fracture is common in facial trauma patients. Although treated through surgical repair, the orbital floor fractures are associated with risk of persisting sensibility disorders, enophthalmos, and permanent diplopia due to complex anatomy of the orbit, time of surgery, and the reconstructive material used for such repairing.Failure of early recognition and treatment of these traumatic injuries may result in functional and cosmetic problems. Autogenous bone grafts are the gold standard for reconstruction of maxillofacial defects. The iliac crest is also considered the most ideal donor site for bone grafting when a large amount of bone is needed. To assess the outcome of early repair of orbital floor fractures regarding enophthalmos, double vision, extrusion, and gait disturbance. A total of 15 patients, all with orbital floor fracture, were enrolled, of which 12 of them were having pure blow-out fractures and 3 patients had impure blow-out fractures. All had undergone primary surgical reconstruction of the orbital floor by autogenous anterior iliac crest within 5-14 days of the injury. The results were as follows: Postoperative complications at recipient site included diplopia (13.3%), enophthalmos (6.7%), and extrusion (6.7%). At the donor site, one patient had pain and the other had gait disturbances, both relieved within 1 month after treatment. Less complications were reported postoperatively with the use of nonvascularized autogenous iliac bone graft.

A retrospective audit of the introduction of a facial trauma admission Proforma

<b>Introduction</b>: Comprehensive documentation has particular pertinence when recording information for facial trauma patients. Patient records have a medico legal value, as a common aetiology of facial trauma is as a result of a criminal event. In addition notes ensure continuity of care whilst being reviewed by multiple members of the team and aid effective surgical decision. Commonly, documentation at presentation is incomplete and varied in format. This retrospective two-cycle audit analysed information captured at initial presentation of surgically managed mandibular fractures at the Queen's Medical Centre, Nottingham, to identify if an improvement in record keeping occurred using a dedicated trauma proforma. <b>Materials and Methods</b>: Ten clerking records before and after proforma introduction were accessed through Medway or DHR computer systems, and analysed against the minimum dataset for documentation stipulated by Royal College of Surgeons of England guidelines. These included dates of injury/assessment; referral source; mechanism of injury; medical history; occlusion; tenderness; dental trauma; imaging; diagnosis and management plan recording. The standard was that 100% of records were complete. <b>Results/Statistics</b>: Prior to the proforma, some data points were consistently not recorded; presence of pain (50%); dental trauma (30%); diagnosis (50%) and analgesia (30%). Overall, the proforma improved record keeping by 26% in data captured, particularly in domains that were poorly recorded. However it should be noted that one third of patients records examined in the second cycle, included completed proformas. <b>Conclusions/Clinical Relevance</b>: This audit demonstrated an increase in data quantity and quality, with the use of a dedicated proforma. With multiple handovers during shifts and frequent staff turnover, a structured proforma prevents information from being omitted and provides a way of obtaining the information needed, in a standardised, reproducible way. A structured proforma aids future audits and assessment of service performance. Furthermore, proformas provided a high education value to junior members of the team, who commonly admit trauma patients, and act as an aid-memoir to guide clinical examination. Consequently, digitalisation of this proforma on Medway, is planned to increase access to the proforma, which is particularly apt for this cohort of patients examined in this study, as access to a paper proforma has its limitations.

Epidemiology of Facial Bone Fractures During the Coronavirus Disease 2019 Pandemic: A Single Korean Level I Trauma Center Study

Purpose The medical community has been heavily impacted by the coronavirus disease 2019 pandemic. The management of facial trauma patients has been affected by the patient capacity of emergency rooms. In this study, we share our experiences of facial trauma management during the social lockdown period and investigate the epidemiological changes in facial bone fractures. Methods A total of 997 patients who presented to Ajou University Hospital Emergency Center and were evaluated by plastic or maxillofacial surgeons for facial trauma were included in this retrospective study. Our study design was a comparative study of two groups: the 2019 group (control) and the 2020 group (the experimental group that experienced social lockdown). Results The total number of emergency room inpatients reflected the national pandemic trends with three peaks in patient numbers. According to these trends, facial bone fractures had two different low points in August 2020 and December 2020. A comparison of the 2019 and 2020 facial bone fractures did not show a statistically significant difference in the total number of patients. An analysis of the causes of trauma showed that domestic accidents increased in 2020 (30.92%; p&amp;lt;0.001). Among the anatomical sites of facial injury in surgical patients, the frontozygomatic complex fracture increased the most in 2020 (p=0.018). Facial injuries with two separate sites of injury or with three or more involved sites also showed a significant increase in 2020 (p&amp;lt;0.001). Conclusions We demonstrated that the incidence of facial trauma patients correlated with the incidence of patients presenting to the emergency department and that facial trauma is inextricably related to multi-trauma cases. Domestic accidents and facial trauma with multiple anatomically involved sites are increasing trends that need more attention.

Initial Assessment of the Facial Trauma Patient

The initial evaluation of the craniofacial trauma patient must be systematic, thorough, and consistent to ensure that injuries are not missed. Life-threatening conditions are first identified using ATLS principles, and focused head and neck examination conducted by a specialist then follows. Imaging is used to guide operative planning, as many craniofacial injuries ultimately benefit from repair to prevent permanent cosmetic or functional deformity. Peri-operative care is often multi-disciplinary in nature, and specialist consultation should be performed in an efficient fashion. Finally, it should be noted that surgeons operating in the maxillofacial region are at high risk for transmission of COVID-19, and risk of COVID-19 sequelae must be balanced with risks associated with the delay of treatment of craniofacial injury.

Prevalence of anxiety and depressive disorders in facial trauma patients: A cross-sectional study

Abstract Background To evaluate the prevalence of anxiety and depressive disorders in facial trauma patients admitted to the Ibn ROCHD University Hospital of Casablanca, we initiated this study. Indeed, facial trauma is damage that can have serious repercussions on the mental health of patients. However, there is little data in Morocco. Methods This was a cross-sectional study conducted at the Ibn Rochd University Hospital in Casablanca from January to April 2019 among facial trauma patients without a history of anxiety and depressive disorders, admitted to the Maxillofacial Surgery Department within 72 hours of the trauma. The patients' socio-demographic and clinical data were collected through a questionnaire, and then the Hospital Anxiety and Depression Scale (HADS) was applied to assess depression and anxiety. In addition to a descriptive analysis of the results, a multinomial regression analysis was performed to assess factors that might be associated with depression and anxiety. Results Among 50 facial trauma patients admitted to the Ibn Rochd University Hospital in Casablanca and included in our study, 11 had symptoms of anxiety (22%) and 12 had symptoms of depression (24%) according to the HADS classification. The mean HADS anxiety and depression subscale scores of the patients were 7.32±4.17 and 6.32±5.10, respectively. Although gender (OR = 2.28 [0.35; 5.70] females), marital status (OR = 3.30 [0.70; 12.70] singles), occupation (OR = 2.66 [0.58; 12.18] not employed), and circumstances of occurrence (OR = 3.66 [0.35; 15.70] public roads) increased the risk of anxiety in patients without anxiety (HADS score≤7); none of these factors was statistically associated with either anxiety or depression. Conclusions This cross-sectional study showed that the prevalence of anxiety and depression in victims of facial trauma is very high in Casablanca. Key messages The prevalence of anxiety and depression among facial trauma victims is very high. Gender, marital status, occupation, and circumstances of occurrence non-significantly increase the risk of anxiety and depression.

The Influence of COVID-19 Lockdown Measures on Maxillofacial Trauma at a Rural Tertiary Academic Center

Introduction: Following the onset of the COVID-19 pandemic, there was an abrupt and widespread shift in the social, political, and economic landscape. The purpose of this study is to analyze the pandemic’s impact on maxillofacial trauma patterns in a predominantly rural setting; the resultant implications for plastic surgery and other trauma-related departments was also considered. Methods: We reviewed records of patients that presented to the University of Vermont with facial trauma who were referred to Plastic Surgery and Otolaryngology during the period spanning from March 25th, 2020 to June 15th, 2020, the first full lockdown in Vermont. We compared this data with referrals made from 2016 to 2019 during the same period. Results: We found 41 patients who presented to UVM with operative facial fractures during the first COVID-19 lockdown period, which compared to an average of 51 over the prior years. Although this is a 20% decrease, it was not statistically significant ( P = .285887). There were also decreases in the mean age (48 vs 40; P = .061333) and increases in the proportion of female patients ( P = .0782055) compared to prior years, but once again no statistically significant change. Mechanism of injury patterns remained consistent with falls being the most common cause during these periods. Fracture types also remained consistent with nasal bone fractures being the most common. Conclusion: Our study shows no statistically significant decrease in volume, change in mechanism, or change in demographics of operative facial trauma patients during the first COVID-19 lockdown period. This was contrary to our expectations and to conventional wisdom, but it does have important implications for hospital staffing and resource allocation. In short, at least for our tertiary care institution serving a large rural population, these results highlight the importance of continued support of plastic and reconstructive surgery as well as related disciplines.

Pre-operative Lab Values and Wound Healing following Facial Trauma Surgery: Which Values Predict Postoperative Complications?

Statement of the problemCan pre-operative lab values be used to predict wound healing in maxillofacial trauma patients? Materials and methodsAn IRB-approved (#4699) retrospective cohort study of patients with maxillofacial trauma that required surgical repair from 2014 to 2020 was performed. Patients treated by OMSs at a single Level I Trauma Center (University of Tennessee Medical Center) were included in the study. The primary predictor variables were preoperative lab values, including serum albumin, WBC, ANC, and lymphocyte count. Complications related to surgical reconstruction of facial injuries represented the primary outcome variable. Methods of data analysisIndependent T-test analysis was completed to assess for significant associations between these objective measures in relation to postoperative complications. A Chi-square test was performed to assess for differences in complication rates based on patient sex. ResultsThe patient cohort included 57 individuals; of whom, 42 were men. There was no difference in complication rates between men and women (P = .47). The average age of the patients at surgery was 38 years. Of these 57 patients, 15 had complications ranging from surgical site infection to prolonged trigeminal nerve hypothesia. When controlling for all other variables, ANC:lymphocyte ratio and number of procedures were both approaching statistical significance P = .097 and .058, respectively. Subjects experiencing complications were found to have an average ANC:lymphocyte ratio of 11.645, while those who had no complications had an average ANC:lympocyte ratio of 7.759. Pre-operative albumin was not found to be statistically significant in maxillofacial trauma patients with a P = .522. Patients without complication had an average albumin of 4.011, and those with complication average an albumin level of 4.143. Outcomes dataSee attached tables. ConclusionLymphocytes are recognized as critical regulators to wound healing via modulation and regulation of growth factors and cytokines.1 Often observed, but rarely characterized, differences in preoperative lymphocyte to neutrophil ratios seem to relate a risk of complication to the patient. Additionally, recent literature has reflected an association between poor nutritional status, with albumin levels used as a surrogate marker, and postoperative complications. This correlation has been noted in oncologic procedures of the head and neck in recent years.2 The authors' study demonstrated that among those individuals meeting the inclusion criteria, there may be an association between higher ANC:lymphocyte levels and postoperative complication rates in facial trauma patients. However, there was no relation between preoperative albumin levels and complications in patients. Further research and data collection are being completed in an effort to increase the power of these results.

Can Positioning an Oral Endotracheal Tube in the Retromolar Space Allow Maxillomandibular Fixation without Occlusal Interference?

PurposeTraumatic maxillofacial injuries requiring maxillomandibular fixation (MMF) traditionally necessitate airway management via tracheostomy or submental intubation. The aim of this study is to understand whether the retromolar space can accommodate passage of a reinforced endotracheal tube (ETT) without interfering with establishing MMF, a technique previously described as retromolar intubation. MethodsA retrospective cross-sectional study was created, including previously treated facial trauma patients by the authors' department as the study sample. From this group, 3D-reconstructed scans were created and used to estimate dimensions of the retromolar space. The averages of these dimensions were calculated and compared to the area occupied by differently sized reinforced ETTs (6.0, 6.5, 7.0, 7.5, 8.0). A 1-sample T-test was used to compare the retromolar areas to each ETT size for all patients and by gender. ResultsForty-one patients, ages 19-69 years old, treated from July 2010 to November 2018 were included in this study. This included 24 males (21-69 years old) and 17 females (19-60 years old), with a total of 81 measurements. The retromolar areas calculated were statistically bigger than the reinforced ETT sizes 6.0 and 6.5 for both males and females, but not statistically significant for reinforced oral ETT sizes 7.0, 7.5 and 8.0. ConclusionThe study results suggest the use of 6.0 and 6.5 reinforced ETTs can be positioned in the retromolar space, therefore allowing the establishment of MMF without occlusal interference. This technique could provide an alternative option to submental intubation or tracheostomy.

Does the Retromolar Area Provide Adequate Space for an Oral Endotracheal Tube Without Interfering With Intermaxillary Fixation?

Traumatic maxillofacial injuries requiring intermaxillaryfixation (IMF) traditionally necessitateairway management via tracheostomy or submental intubation. The aim of this study is to understand whether the retromolar space can accommodate passage of a reinforced endotracheal tube (ETT) without interfering with establishing IMF, a technique previously described as retromolar intubation. A retrospective cross-sectional study was created including previously treated facial trauma patients by our department as the study sample. From this group, 3D reconstructed scans were created and used to estimate that dimensions of the retromolar space. The averages of these dimensions were calculated and compared to the area occupied by different sized reinforced ETTs (6.0, 6.5, 7.0, 7.5, 8.0). A 1-sample t-test was used to compare the retromolar areas to each ETT size for all patients and by gender. Forty-one patients, ages 19-69 years old, treated from July 2010 to November 2018 were included in this study. This included 24 males (21-69yo) and 17 females (19-60yo), with a total of 80 characteristics measured. The retromolar areas calculated were statistically bigger than the reinforced ETT sizes 6.0, 6.5, and 7.0 compared to the average retromolar space area, but not statistically significant for reinforced oral ETT sizes 7.5 and 8.0. Our study results suggest the use of 6.0, 6.5 and 7.0 reinforced ETTs canbepositioned in the retromolar space, allowing the surgeon to place a patient in IMF without occlusal interference. This technique couldprovidean alternativeoptionto submental intubation or tracheostomy.

Pediatric Orbital Entrapment: Radiographic Findings and Their Predictive Values.

Although orbital fractures are less common in children than adults, the literature suggests that orbital entrapment occurs more frequently in the pediatric population. Orbital entrapment is an emergency, and early diagnosis and prompt management are critical. Specific radiographic manifestations such as herniation of extraocular muscles (EOMs) through orbital fractures have led to increased suspicion and overdiagnosis of orbital entrapment. This study evaluated the value of specific radiographic findings in predicting clinical findings after pediatric orbital floor fractures. A retrospective review at a pediatric level 1 trauma center was performed. ICD-9 and ICD-10, codes identified patients with orbital fractures. Computed tomography (CT) reports were queried for the following terms: "herniation," "herniated," "entrapped," and "entrapment." Patients 16 years and older were excluded, as were all patients who were unable to undergo EOM evaluation on presentation. Electronic medical records were reviewed for fracture type, mechanism of injury, clinical and radiographic findings, surgical interventions, and demographic information. Medical diagnosis tests, including positive and negative predictive values, sensitivity, as well as specificity, were calculated to identify the relationship between radiographic findings and specific symptomology. One hundred fifty-three patients with 265 orbital fractures were included. "Entrapment" was mentioned in 34.6% of CT reports, whereas the incidence of clinical entrapment was 12.4% (19/153). Radiographic fat herniation, EOM herniation, and EOM irregularity had positive predictive values of 25%, 31%, and 10%, respectively, for clinical entrapment diagnosis at the initial examination. Overall, 32.7% (50/153) of patients with orbital fractures required surgery. Although the radiographic description of soft tissue herniation has become interchangeable with entrapment, these CT findings alone are poorly predictive. Orbital entrapment should be diagnosed preoperatively by physical examination, with radiographs as an adjunct only. Radiographic statements without clinical correlation may lead to the improper management of pediatric facial trauma patients.

Secondary overtriage of isolated facial trauma

DesignRetrospective chart review. SettingAcademic, tertiary care, level I trauma center in a rural state. BackgroundUnnecessary transfer of certain facial trauma patients results in a burden of time, money, and other resources on both the patient and healthcare system; identification and development of outpatient treatment pathways for these patients is a significant opportunity for cost savings. ObjectivesTo investigate the treatment and disposition of un-complicated, stable, isolated facial trauma injuries transferred from outside hospitals and determine the significance of secondary overtriage. MethodsRetrospective chart review utilizing our institutional trauma database, including patients transferred to our emergency department between January 2012 and December 2017. Patients were identified by ICD9 or ICD10 codes and only those with isolated facial trauma were included. ResultsWe identified 538 isolated facial trauma patients who were transferred to our institution during the study period. The majority of those patients were transferred via ground ambulance for an average of 76 miles. Overall, 82% of patients (N = 440) were discharged directly from our institution's emergency department. Almost 30% of patients did not require any formal treatment for their injuries; the potential savings associated with elimination of these unnecessary transfers was estimated to be between $388,605 and $771,372. ConclusionsWe identified a high rate of patients with stable, isolated facial trauma that could potentially be evaluated and treated without emergent transfer. The minimization of these unnecessary transfers represents a significant opportunity for cost and resource utilization savings. Level of evidence2b- Economic and Cost Analysis.

Real-time screening tool for identifying post-traumatic stress disorder in facial trauma patients in a UK maxillofacial trauma clinic

Post-traumatic stress disorder (PTSD) is a distressing consequence of a traumatic event associated with an increased suicide risk and reduced quality of life. Surgeons often have low confidence in identifying psychological problems. The prevalence of PTSD following facial trauma ranges from 23% to 41%. This highlights the importance of identifying and managing at-risk patients to optimize both mental and physical recovery. IMPARTS (Integrating Mental and Physical healthcare: Research, Training and Services) provides electronic screening tools to guide the non-mental health clinician in the ‘real-time’ identification, documentation, and management of potential mental health problems. The bespoke IMPARTS facial trauma screening tool was piloted in a UK oral and maxillofacial surgery trauma clinic from July 2015 to November 2017. A total of 199 patients completed screening, with 48 (24%) screening positive for possible PTSD. Further analysis of these 48 patients revealed that four (8%) had PTSD symptoms alone; three (6%) also screened positive for depression, 17 (35%) for co-existing symptoms of anxiety, and 24 (50%) for PTSD, anxiety, and depression. IMPARTS was found to be a highly effective tool aiding the non-mental health clinician to screen for PTSD and initiate prompt management. The data captured informs planning of the psychological support service.

Treatment of Facial Fractures at Safety-Net Hospitals: A National Analysis of Inpatient Burden and Cost.

Safety-net hospitals (SNHs) are vital in the care of trauma populations, but little is known about the burden of facial trauma presenting to SNHs. The authors sought to characterize the presentation and treatment of facial fractures across SNHs and determine the association between SNH care and healthcare utilization in patients undergoing fracture repair. Adult patients presenting with a facial fracture as their primary admitting diagnosis from the year 2012 to 2015 were identified in the National Inpatient Sample. The "safety-net burden" of each hospital was defined based on the proportion of Medicaid and self-pay discharges. Patient factors analyzed were sex, race, age, income level, insurance status, fracture location, and comorbidities. Hospital factors analyzed were safety-net burden, teaching status, geographic region, bed size, and ownership status. The main outcomes were length of stay (LOS), hospital costs, time to repair, and postoperative complications. Of 78,730 patients, 27,080 (34.4%) were treated at SNHs and 24,844 (31.6%) were treated at non-SNHs. Compared to non-SNHs, patients treated at SNHs were more likely to undergo operative repair at SNHs (65.8% versus 53.9%, P < 0.001). Overall mean LOS was comparable between non-SNH and SNH (3.43 versus 3.38 days, P = 0.611), as was mean hospital cost ($15,487 versus $15,169, P = 0.434). On multivariate linear regression, safety-net status was not a predictor of increased LOS, cost, or complications. However, safety-net status was significantly associated with lower odds of undergoing repair within 48 hours of admission (odds ratio 0.783, 95% confidence interval = 0.680-0.900, P = 0.001). Safety-net hospitals are able to treat facial trauma patients with greater injury burden and lower socioeconomic resources without increased healthcare utilization. Healthcare reform must address the financial challenges that endanger these institutions to ensure timely treatment of all patients.

Injury Patterns in Pediatric Facial Fractures Unique to an Urban Environment.

This study aimed to define better the clinical presentation, fracture patterns, and features predictive of associated injuries and need for surgery in pediatric facial trauma patients in an urban setting. Charts of patients 18 years or younger with International Classification of Disease 9th and 10th revision (ICD-9/ICD-10) codes specific for facial fractures (excluding isolated nasal fractures) at NY-Presbyterian/Weill Cornell Medical Center between 2008 and 2017 were retrospectively reviewed. Of 204 patients, most were referred to the emergency department by a physician's office or self-presented. Children (age 0-6 years) were most likely to have been injured by falls, while more patients 7 to 12 years and 13 to 18 years were injured during sporting activities (p < 0.0001). Roughly half (50.5%) of the patients had a single fracture, and the likelihood of surgery increased with greater numbers of fractures. Older patients with either orbital or mandibular fractures were more likely to undergo surgery than younger ones (p = 0.0048 and p = 0.0053, respectively). Cranial bone fractures, CSF leaks, and intracranial injuries were more common in younger patients (p < 0.0001) than older patients and were more likely after high energy injuries; however, 16.2% of patients sustaining low energy injuries also sustained cranial bone, CSF leak, or intracranial injury. In an urban environment, significant pediatric facial fractures and associated injuries may occur after nonclassic low kinetic energy traumatic events. The age of the patient impacts both the injuries sustained and the treatment rendered. It is essential to maintain a high index of suspicion for associated injuries in all pediatric facial trauma patients.