Nationwide Patterns of Injury and Management of Pediatric Facial Trauma from 2007 to 2015
Selim G. Gebran, MD1, Philip J. Wasicek, MD2, Adekunle Elegbede, MD, PhD3, Ledibabari M. Ngaage, MB BChir4, Yuanyuan Liang, PhD5, Marcus Ottochian, MD, PhD6, Jonathan J. Morrison, PhD, MBBS5, Michael P. Grant, MD, PhD1, Yvonne M. Rasko, MD4, Fan Liang, MD1, Arthur J. Nam, MD1.
1Division of Plastic and Reconstructive Surgery, R Adams Cowley Shock Trauma Center, Baltimore, MD, USA, 2Department of General Surgery, University of Maryland School of Medicine, Baltimore, MD, USA, 3Department of Plastic and Reconstructive Surgery, The Johns Hopkins University, Baltimore, MD, USA, 4Division of Plastic and Reconstructive Surgery, University of Maryland School of Medicine, Baltimore, MD, USA, 5Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA, 6Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, USA.
BACKGROUND:Craniofacial injuries are the most common traumatic injuries seen in the pediatric population. The aim of this study is to characterize craniofacial fracture patterns and its contemporary management in the United States pediatric population.
METHODS:The National Trauma Data Bank was used to examine demographics and clinical characteristics of patients 18 years of age and younger, admitted to US trauma centers between 2007 and 2015. Craniofacial fractures along with associated reconstructive procedures performed at index admission were selected based on ICD-9 and Abbreviated Injury Score (AIS) codes. A multivariate analysis was used to determine independent predictors of surgical repair. Orbit fractures were excluded from the multivariate analysis because of low operative rates at index admission.
RESULTS: A total of 74,001 patients met inclusion criteria. The mean patient age was 12.6 years (SD=5.3) and the male to female ratio was 2.3:1. Falls were the most common mechanism of injury in infants and toddlers (age <2-years-old, 44.4%), while motor vehicle collisions (32.9%) and assault (22.1%) were most commonly seen in adolescents (age 12- to 18-years-old) (Table 1). The median Injury Severity Score was 9 (IQR [5-9]) and 78.3% of all patients had isolated craniofacial injury. Orbital fractures were most commonly seen across age groups (37.2%) with the highest incidence in infants and toddlers (47.8%). Nasal and zygoma fractures were most commonly seen in adolescents (37%, 7.9% respectively). With increasing age, a larger fraction of fractures was repaired at index admission (from 8.1% to 28.2%) (Figure 1), more so with open than closed reduction in adolescents (73%) as compared to infants and toddlers (50.3%). The occurrence of combined fractures is described in (Figure 2). Concomitant cervical spine injuries occurred at similar rates with mandible, orbit and nasal fractures (Figure 2). Median time to first facial procedure was 1 day, with mandible fractures being the most commonly operated facial fractures (38.4% with open; 23.3% with closed reduction) (Figure 3). Multiple fractures of the mandible or nose were twice as likely to be repaired as compared to isolated fractures (P<0.001). Similar odds of repair were observed with multiple fractures that were not localized to one bone, when compared to isolated fractures (OR 1.89-3.16, P<0.001) (Table 2). The odds of each type of repair have not varied significantly over the eight-years study period.
CONCLUSIONS: Most pediatric facial fractures are managed non-operatively, however the operative rate increases with advancing age. Mandible fractures and combined fractures, regardless of the location of the second fracture, are most likely to be repaired early after trauma.
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