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PSRC 60th Annual Meeting

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Validation of Clinical Criteria for Obtaining Maxillofacial CT in Trauma Patients
Nyama Sillah, MD1, Thomas Sitzman, MD2, Summer Hanson, MD, Ph.D3, Lindell Gentry, MD1, John Doyle, DDS1, Karol Gutowski, MD4.
1University of Wisconsin, Madison, WI, USA, 2Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA, 3University of Texas MD Anderson Cancer Center, Houston, TX, USA, 41526 Kittyhawk Lane, Glenview, IL, USA.

Validation of Clinical Criteria for Obtaining Maxillofacial CT in Trauma Patients
Thomas J. Sitzman, M.D., Nyama M. Sillah, M.D., Summer E. Hanson, M.D., Lindell R.
Gentry, M.D., John F. Doyle, D.D.S., Karol A. Gutowski, M.D.
Purpose: Each year over 180,000 patients present to emergency departments in the United States with facial trauma. Of these, approximately one-third will have a facial fractures. While maxillofacial computed tomography (CT) has become the gold standard in identifying facial fractures, the indiscriminate use of CT brings increased cost and unnecessary radiation exposure. In a previous study, the authors developed a set of
clinical criteria (decision instrument) that identified patients at low risk of facial fracture who could avoid CT imaging. The present study aims to internally validate that instrument.

Methods: A retrospective observational study was conducted on all patients evaluated at a Level I trauma center over a one year period. Inclusion criteria were maxillofacial physical exam, head CT, and maxillofacial CT at presentation. The decision instrument used five criteria: bony stepoff or instability, periorbital swelling or contusion, Glasgow Coma Scale less than 14, malocclusion and tooth absence. The presence of any one finding placed the patient at high risk for fracture.

Results: A total of 179 patients met enrollment criteria. Fracture of the maxillofacial skeleton occurred in 81% of patients (n=145). The decision instrument was 97.4% sensitive (95% CI, 93.8-99.3) for the presence of facial fracture. The negative predictive value was 81.3% (95% CI, 55.0-95.0). Application of the instrument to the study population would have missed three patients with facial fractures, for a missed injury rate of 2.6%. All missed fractures were non-displaced and managed non-operatively. If only
patients meeting the criteria obtained imaging, CT use would have decreased by 8.9%.

Conclusions: The proposed decision instrument may assist providers in identifying patients that need maxillofacial CT. Patients with any of the five clinical criteria are at high risk for facial fracture and should undergo CT imaging. Application of the instrument may reduce maxillofacial CT use without missing fractures requiring operative intervention.
Keywords: Maxillofacial, Trauma, Decision Instrument, Validation

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