A. W. Harrington1, K. Pei1, R. Assi1, K. A. Davis1 1Yale University School Of Medicine,Department Of Surgery,New Haven, CT, USA
Introduction:
Patients sustaining multisystem trauma are at risk for oral and maxillofacial fractures. To date, no externally validated criteria is available to guide the clinician in obtaining additional cross sectional imaging to evaluate possible facial fractures. Our aim was to externally validate the University of Wisconsin’s Criteria and to report modern practice patterns at a tertiary, academic, Level 1 trauma center.
Methods:
A retrospective case study was performed of all patients who had computed tomography of the facial bones (CT face) at a tertiary, academic, Level 1 trauma center over the 6-month period ending June 30, 2015. The electronic medical record was reviewed for the five University of Wisconsin criteria (bony step off or instability, periorbital ecchymosis, malocclusion, tooth absence, and GCS). Final interpretation of CT face findings (facial fractures, intracranial hemorrhage, and cervical spine injury) were also captured. Our modeling was similar to that described by Sitzman, et al. Sensitivity, specificity, negative and positive predictive values with 95% confidence intervals were evaluated. A p<0.05 was considered significant.
Results:
The presence of any one or more of the five criteria identified on physical exam resulted in an 81% sensitivity for any facial fracture which is lower than the sensitivity initially described (97%). The absence of all five physical examination criteria had a negative predictive value of 60%, again lower than that initially described (81%).
Conclusion:
We were unable to validate the University of Wisconsin criteria for predicting facial fractures. These criteria may be institutionally specific and not generalizable to other trauma centers. Further research to refine the criteria for CT of the face is needed to improve resource allocation.
