Clinical and radiographic predictors of the need for facial CT in pediatric blunt trauma: a multi-institutional study
Background Facial injuries are common in children with blunt trauma. Most are soft tissue lacerations and dental injuries readily apparent on clinical examination. Fractures requiring operative intervention are rare. Guidelines for utilization of maxillofacial CT in children are lacking. We hypothes...
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BMJ Publishing Group
2022-10-01
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| Series: | Trauma Surgery & Acute Care Open |
| Online Access: | https://tsaco.bmj.com/content/7/1/e000899.full |
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| author | Thais Calderon Mitchell Chess Brittany N Nguyen Mary J Edwards Shachi Srivatsa Derek Wakeman Abdularouf Lamoshi Kim Wallenstein Tiffany Fabiano Brittany Cantor Kathryn Bass Ananth Narayan Ralph Zohn Richard D Thomas |
| author_facet | Thais Calderon Mitchell Chess Brittany N Nguyen Mary J Edwards Shachi Srivatsa Derek Wakeman Abdularouf Lamoshi Kim Wallenstein Tiffany Fabiano Brittany Cantor Kathryn Bass Ananth Narayan Ralph Zohn Richard D Thomas |
| author_sort | Thais Calderon |
| collection | DOAJ |
| description | Background Facial injuries are common in children with blunt trauma. Most are soft tissue lacerations and dental injuries readily apparent on clinical examination. Fractures requiring operative intervention are rare. Guidelines for utilization of maxillofacial CT in children are lacking. We hypothesized that head CT is a useful screening tool to identify children requiring dedicated facial CT.Methods We conducted a multicenter retrospective review of children aged 18 years and under with blunt facial injury who underwent both CT of the face and head from 2014 through 2018 at five pediatric trauma centers. Penetrating injuries and animal bites were excluded. Imaging and physical examination findings as well as interventions for facial fracture were reviewed. Clinically significant fractures were those requiring an intervention during hospital stay or within 30 days of injury.Results 322 children with facial fractures were identified. Head CT was able to identify a facial fracture in 89% (287 of 322) of children with facial fractures seen on dedicated facial CT. Minimally displaced nasal fractures, mandibular fractures, and dental injuries were the most common facial fractures not identified on head CT. Only 2% of the cohort (7 of 322) had facial injuries missed on head CT and required an intervention. All seven had mandibular or alveolar plate injuries with findings on physical examination suggestive of injury.Discussion In pediatric blunt trauma, head CT is an excellent screening tool for facial fracture. In the absence of clinical evidence of a mandibular or dental injury, a normal head CT will usually exclude a clinically significant facial fracture.Level of evidence III. |
| format | Article |
| id | doaj-art-4aec06921f784cd7a01cd59ebfb0e2ad |
| institution | OA Journals |
| issn | 2397-5776 |
| language | English |
| publishDate | 2022-10-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Trauma Surgery & Acute Care Open |
| spelling | doaj-art-4aec06921f784cd7a01cd59ebfb0e2ad2025-08-20T02:07:34ZengBMJ Publishing GroupTrauma Surgery & Acute Care Open2397-57762022-10-017110.1136/tsaco-2022-000899Clinical and radiographic predictors of the need for facial CT in pediatric blunt trauma: a multi-institutional studyThais Calderon0Mitchell Chess1Brittany N Nguyen2Mary J Edwards3Shachi Srivatsa4Derek Wakeman5Abdularouf Lamoshi6Kim Wallenstein7Tiffany Fabiano8Brittany Cantor9Kathryn Bass10Ananth Narayan11Ralph Zohn12Richard D Thomas13Division of Plastic and Reconstructive Surgery, University of Washington, seattle, Washington, USADepartment of Imaging Sciences, URMC, Rochester, NY, USADepartment of Surgery, Albany Medical Center, Albany, New York, USASurgery, Albany Medical College, Albany, New York, USADepartment of Surgery, Ohio State University Foundation, Columbus, Ohio, USADepartment of Surgery, University of Rochester, Rochester, New York, USADepartment of Surgery, Long Island Jewish Medical Center Northwell Health Cancer Institute, New Hyde Park, New York, USADepartment of Surgery, Upstate Golisano Children`s Hospital, Syracuse, New York, USATrauma Surgery Division, John R Oishei Children’s Hospital, Buffalo, New York, USATrauma Surgery Division, John R Oishei Children’s Hospital, Buffalo, New York, USADepartment of Surgery, University at Buffalo, Buffalo, New York, USADepartment of Radiology, Albany Medical Center, Albany, New York, USADepartment of Radiology, Long Island Jewish Medical Center Northwell Health Cancer Institute, New Hyde Park, New York, USADepartment of Radiology, John R Oishei Children`s Hospital, Buffalo, New York, USABackground Facial injuries are common in children with blunt trauma. Most are soft tissue lacerations and dental injuries readily apparent on clinical examination. Fractures requiring operative intervention are rare. Guidelines for utilization of maxillofacial CT in children are lacking. We hypothesized that head CT is a useful screening tool to identify children requiring dedicated facial CT.Methods We conducted a multicenter retrospective review of children aged 18 years and under with blunt facial injury who underwent both CT of the face and head from 2014 through 2018 at five pediatric trauma centers. Penetrating injuries and animal bites were excluded. Imaging and physical examination findings as well as interventions for facial fracture were reviewed. Clinically significant fractures were those requiring an intervention during hospital stay or within 30 days of injury.Results 322 children with facial fractures were identified. Head CT was able to identify a facial fracture in 89% (287 of 322) of children with facial fractures seen on dedicated facial CT. Minimally displaced nasal fractures, mandibular fractures, and dental injuries were the most common facial fractures not identified on head CT. Only 2% of the cohort (7 of 322) had facial injuries missed on head CT and required an intervention. All seven had mandibular or alveolar plate injuries with findings on physical examination suggestive of injury.Discussion In pediatric blunt trauma, head CT is an excellent screening tool for facial fracture. In the absence of clinical evidence of a mandibular or dental injury, a normal head CT will usually exclude a clinically significant facial fracture.Level of evidence III.https://tsaco.bmj.com/content/7/1/e000899.full |
| spellingShingle | Thais Calderon Mitchell Chess Brittany N Nguyen Mary J Edwards Shachi Srivatsa Derek Wakeman Abdularouf Lamoshi Kim Wallenstein Tiffany Fabiano Brittany Cantor Kathryn Bass Ananth Narayan Ralph Zohn Richard D Thomas Clinical and radiographic predictors of the need for facial CT in pediatric blunt trauma: a multi-institutional study Trauma Surgery & Acute Care Open |
| title | Clinical and radiographic predictors of the need for facial CT in pediatric blunt trauma: a multi-institutional study |
| title_full | Clinical and radiographic predictors of the need for facial CT in pediatric blunt trauma: a multi-institutional study |
| title_fullStr | Clinical and radiographic predictors of the need for facial CT in pediatric blunt trauma: a multi-institutional study |
| title_full_unstemmed | Clinical and radiographic predictors of the need for facial CT in pediatric blunt trauma: a multi-institutional study |
| title_short | Clinical and radiographic predictors of the need for facial CT in pediatric blunt trauma: a multi-institutional study |
| title_sort | clinical and radiographic predictors of the need for facial ct in pediatric blunt trauma a multi institutional study |
| url | https://tsaco.bmj.com/content/7/1/e000899.full |
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