Harrington Amanda W, Pei Kevin Y, Assi Roland, Davis Kimberly A
Department of Surgery.
Section of General Surgery, Trauma, and Surgical Critical Care, Department of Surgery, Yale School of Medicine, New Haven, CT.
J Craniofac Surg. 2018 Mar;29(2):e167-e170. doi: 10.1097/SCS.0000000000004240.
Patients sustaining multisystem trauma are at risk for oral and maxillofacial fractures. Although the University of Wisconsin established criteria to help guide the clinician in obtaining additional cross-sectional imaging to evaluate possible facial fractures, it has not been externally validated. Our aim was to evaluate whether the University of Wisconsin's Criteria is generalizable to external institutions through validation and to report modern practice patterns at a level 1 trauma center.
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 on June 30, 2015. The electronic medical record was reviewed for the 5 University of Wisconsin criteria (bony step off or instability, periorbital ecchymosis, malocclusion, tooth absence, and glasgow coma scale). Final interpretation of CT face findings by board-certified radiologists (facial fractures, intracranial hemorrhage, and cervical spine injury) were also captured. Our modeling was similar to that described by the reference study, the internal validation study. Sensitivity, specificity, negative, and positive predictive values with 95% confidence intervals were evaluated. A P < 0.05 was considered significant.
The presence of any ≥1 of the 5 criteria identified on physical examination resulted in 81% sensitivity for any facial fracture, which is lower than the sensitivity initially described (98%) and subsequently internally validated (97%). The absence of all 5 physical examination criteria had a negative predictive value of 60%, again lower than that initially described (87%) and then internally validated (81%).
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.
遭受多系统创伤的患者有发生口腔颌面部骨折的风险。尽管威斯康星大学制定了标准以帮助指导临床医生获取额外的横断面成像来评估可能的面部骨折，但该标准尚未经过外部验证。我们的目的是通过验证评估威斯康星大学的标准是否可推广至外部机构，并报告一级创伤中心的现代实践模式。
对2015年6月30日结束的6个月期间在一家三级学术性一级创伤中心接受面部骨骼计算机断层扫描（CT面部）的所有患者进行回顾性病例研究。查阅电子病历以了解威斯康星大学的5项标准（骨台阶或不稳定、眶周瘀斑、咬合不正、牙齿缺失和格拉斯哥昏迷量表）。还记录了经董事会认证的放射科医生对CT面部检查结果的最终解读（面部骨折、颅内出血和颈椎损伤）。我们的建模与参考研究（内部验证研究）中描述的相似。评估了敏感性、特异性、阴性和阳性预测值以及95%置信区间。P<0.05被认为具有统计学意义。
体格检查中发现任何≥1项这5项标准，对任何面部骨折的敏感性为81%，低于最初描述的敏感性（98%）和随后内部验证的敏感性（97%）。所有5项体格检查标准均不存在时，阴性预测值为60%，同样低于最初描述的（87%）和随后内部验证的（81%）。
我们无法验证威斯康星大学预测面部骨折的标准。这些标准可能具有机构特异性，无法推广至其他创伤中心。需要进一步研究完善面部CT标准以改善资源分配。
