Allison James R, Kearns Andrew, Banks Robert J
Clinical Fellow in Oral Surgery, School of Dental Sciences, Newcastle University, Framlington Place, Newcastle upon Tyne, NE2 4BW, UK.
Manchester University, Manchester, UK.
Emerg Radiol. 2020 Feb;27(1):31-36. doi: 10.1007/s10140-019-01720-0. Epub 2019 Aug 30.
Patients presenting to emergency departments (EDs) following head injury often undergo computed tomography (CT) of the head to exclude traumatic brain injury. In many cases, this does not show the maxillofacial skeleton. A proportion of these patients also sustain facial fractures, and when fractures involve the orbits, CT imaging is useful in diagnosis and management; obtaining a second scan may cause delay, incur greater cost, and increase radiation dose. The aim of this preliminary study was to examine the value of signs and symptoms of orbital fractures in predicting a fracture on CT.
The clinical records of 47 patients who underwent CT of the face following facial trauma were retrospectively examined for the presence of signs and symptoms of orbital fractures. Sensitivity, specificity, negative predictive value (NPV) and positive predictive values (PPV) were then calculated for each sign and symptom for the presence of an orbital fracture on CT. We also described a clinical decision instrument and examined the predictive values of this.
Change in the position of the globe, reduced visual acuity, subconjunctival haemorrhage and change in sensation in the maxillary division of the trigeminal nerve were the most specific signs and symptoms for orbital fracture. Our clinical decision instrument had 80.0% sensitivity, 75.0% specificity, 90.3% PPV and 56.3% NPV for predicting the presence of an orbital fracture on CT in this population.
Our results demonstrate that signs and symptoms of orbital fractures may be useful for predicting these injuries, and a decision instrument could be used in the ED to identify patients likely to benefit from extending the radiation field to include the orbits where CT of the head is already planned. This work is however exploratory; and further prospective validation is required before a robust instrument can be recommended for clinical use.
头部受伤后前往急诊科（ED）就诊的患者通常会接受头部计算机断层扫描（CT）以排除创伤性脑损伤。在许多情况下，这种扫描并未显示颌面骨骼。这些患者中有一部分也会发生面部骨折，当骨折累及眼眶时，CT成像对诊断和治疗很有用；进行第二次扫描可能会导致延误、成本增加以及辐射剂量增大。这项初步研究的目的是探讨眼眶骨折的体征和症状在预测CT上骨折情况时的价值。
回顾性检查47例面部创伤后接受面部CT检查的患者的临床记录，以确定是否存在眼眶骨折的体征和症状。然后针对每个体征和症状计算其对于CT上存在眼眶骨折的敏感性、特异性、阴性预测值（NPV）和阳性预测值（PPV）。我们还描述了一种临床决策工具并检验了其预测价值。
眼球位置改变、视力下降、结膜下出血以及三叉神经上颌支感觉改变是眼眶骨折最具特异性的体征和症状。在该人群中，我们的临床决策工具对于预测CT上存在眼眶骨折的敏感性为80.0%，特异性为75.0%，PPV为90.3%，NPV为56.3%。
我们的结果表明，眼眶骨折的体征和症状可能有助于预测这些损伤，并且可以在急诊科使用一种决策工具来识别那些可能会从扩大辐射野以包括眼眶（在已经计划进行头部CT检查的情况下）中获益的患者。然而，这项工作是探索性的；在推荐一种可靠的工具用于临床之前，还需要进一步的前瞻性验证。
