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Abstract: 14.40 A Retrospective Examination Of Three Unique Clinical Scoring Systems To Rule Out Craniofacial Fractures Without Ct Imaging

2017; Wolters Kluwer; Volume: 5; Issue: 1S Linguagem: Inglês

10.1097/01.gox.0000512424.03973.11

2169-7574

Pierce Janssen, Gabriel Klein, Ramsen Azizi, Muntazim Mukit, Alexander B. Dagum,

Facial Trauma and Fracture Management

INTRODUCTION: CT imaging is currently the gold standard for ruling out facial fractures. Unfortunately, it exposes patients without fractures to unnecessary radiation and increases medical costs. Previous analyses by Sitzman and Exadaktylos have highlighted clinical criteria to rule out facial fractures, but have not been applied to other patient populations. In this study, we applied these diagnostic scales to our institutionÕs patient population and compared their effectiveness to that of our own unique criteria. MATERIALS AND METHODS: Medical records of traumatic adult craniofacial fracture patients presenting to our institution between July 2012 and December 2014 were reviewed. Documented physical exam findings were applied to the three diagnostic scales and correlated with location specific imaging results. Negative predictive value, sensitivity, positive predictive value, and specificity were calculated for each scale for orbital, mandibular, nasal, and zygomatic fractures. Our Stony Brook Scale and Sitzmans Scale were applicable to all four facial areas, while Exadaktylos Scale was applicable only to the orbit. RESULTS: Our cohort included 319 patients. Stony Brook Scale NPVs were strong for nasal, zygomatic, and mandibular fractures (92%, 85%, and 82%, respectively). Sitzmans Scale NPVs were significantly weaker for these same areas (28%, 28%, and 31%, respectively). Exadaktylos Scale provided the strongest NPV for orbital fractures (72%), which was negligibly higher than that of the Stony Brook Scale (69%), and noticeably higher than that of Sitzmans Scale (47%). All scales showed high sensitivities, ranging from 76–92%. CONCLUSIONS: In the clinical setting, NPV is the best statistical tool for determining a test’s ability to confidently rule out facial fractures without CT imaging. The Stony Brook Scale is very efficient when investigating each particular part of the face. These findings encourage future prospective analysis and suggest that proper application of these criteria may help to avoid unnecessary CT imaging for facial trauma patients.