Scolozzi Paolo, Jacquier Paul, Courvoisier Delphine S
*Department of Surgery, Division of Oral and Maxillofacial Surgery, University of Geneva & University Hospitals of Geneva †Department of Clinical Neurosciences, Division of Ophthalmology, University Hospital and Faculty of Medicine of Geneva ‡Biostatistician, Department of Surgery, Division of Oral and Maxillofacial Surgery, University of Geneva & University Hospitals of Geneva, Geneva, Switzerland.
J Craniofac Surg. 2017 Oct;28(7):e661-e667. doi: 10.1097/SCS.0000000000003823.
The aim of this study was to determine the predictive value of 4 clinical signs (periorbital ecchymosis, periorbital emphysema, diplopia, and inferior orbital nerve hypoesthesia) for the diagnosis of orbital fractures (OFs) and the need for surgical treatment in patients with orbital trauma. The investigators designed and implemented a retrospective cohort study composed of patients with orbital trauma. The primary and secondary outcomes were respectively the diagnosis of OFs and the need for surgical treatment. Multivariable logistic regressions including the clinical signs, age, and causes of injury were used to determine the independent contribution of each clinical sign to the prediction of the outcomes and to obtain weights to compute OF and surgery scores. The outcomes were assessed by receiver-operating characteristic (ROC) curves, sensitivity, specificity, and positive and negative predictive values. A total of 912 patients were included. All clinical signs except periorbital ecchymosis were significantly associated with OFs and the need for surgical treatment (P < 0.001). The predictive power of each clinical sign taken separately was moderate for the 2 outcomes (area under ROC curve [AUC] <0.7). A better predictive value was found when all clinical signs were used together (AUC >0.7). Patients with an OF score >3 were likely to have an OF and patients with a surgery score ≤2 were unlikely to have surgery.The present study demonstrated that our OF and surgery scores resulted in an effective model that allowed the stratification of patients with orbital trauma based on their risk of having OFs and risk of needing a surgical treatment.
本研究的目的是确定4种临床体征（眶周瘀斑、眶周气肿、复视和眶下神经感觉减退）对眼眶骨折（OFs）诊断的预测价值以及眼眶外伤患者手术治疗的必要性。研究人员设计并实施了一项由眼眶外伤患者组成的回顾性队列研究。主要和次要结局分别是OFs的诊断和手术治疗的必要性。使用包括临床体征、年龄和损伤原因的多变量逻辑回归来确定每种临床体征对结局预测的独立贡献，并获得权重以计算OF和手术评分。通过受试者操作特征（ROC）曲线、敏感性、特异性以及阳性和阴性预测值来评估结局。共纳入912例患者。除眶周瘀斑外，所有临床体征均与OFs及手术治疗的必要性显著相关（P<0.001）。单独考虑每种临床体征时，对这2种结局的预测能力中等（ROC曲线下面积[AUC]<0.7）。当所有临床体征一起使用时，发现具有更好的预测价值（AUC>0.7）。OF评分>3的患者可能患有OF，手术评分≤2的患者不太可能接受手术。本研究表明，我们的OF和手术评分产生了一个有效的模型，该模型能够根据眼眶外伤患者发生OFs的风险和需要手术治疗的风险对其进行分层。
