Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Department of Oral and Maxillofacial Diseases, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
Int J Oral Maxillofac Surg. 2020 Nov;49(11):1439-1444. doi: 10.1016/j.ijom.2020.06.008. Epub 2020 Jul 14.
The purpose of this study was to clarify the frequency of missed mandibular fractures and to identify possible predictive factors for missed diagnosis. This was a retrospective study that included patients <20 years of age with a recent mandibular fracture. The outcome variable was missed mandibular fracture, which was determined when a fracture was not suspected or diagnosed during the patient's first assessment in primary healthcare. The primary predictor variable was age group (i.e. children <13 years or teenagers/adolescents aged 13-19 years). The explanatory variables were sex, mechanism of injury, and type of facial facture. Other variables were clinical symptoms and findings. Mandibular fracture was missed at first contact in 27 of 182 patients (14.8%). Fracture was missed significantly more often in patients <13 years than in older patients (33.3% vs. 8.8%, P<0.001). The only significant symptom or clinical finding that was associated with missed fractures was skin wound of the jaw (P=0.009). There was no association between missed fracture and sex or mechanism of injury. Mandibular fractures in children are often missed at the first healthcare contact. Careful examination is necessary in paediatric mandibular injuries, particularly in the youngest age groups. Consultation should be smooth between paediatric trauma units and maxillofacial surgeons.
本研究旨在阐明下颌骨骨折漏诊的频率，并确定可能的漏诊预测因素。这是一项回顾性研究，纳入了年龄在 20 岁以下且近期有下颌骨骨折的患者。结局变量是下颌骨骨折漏诊，当在初级保健中首次评估时未怀疑或诊断出骨折时，则认为存在漏诊。主要预测变量是年龄组（即<13 岁的儿童或 13-19 岁的青少年）。解释变量为性别、损伤机制和面部骨折类型。其他变量为临床症状和发现。在 182 名患者中，有 27 名（14.8%）在首次就诊时漏诊了骨折。<13 岁的患者骨折漏诊的发生率明显高于年龄较大的患者（33.3%比 8.8%，P<0.001）。唯一与漏诊骨折相关的显著症状或临床发现是下颌皮肤伤口（P=0.009）。骨折漏诊与性别或损伤机制之间无关联。儿童下颌骨骨折在首次医疗接触时经常漏诊。在儿童下颌骨损伤中，需要仔细检查，特别是在年龄最小的年龄组。儿科创伤单位和颌面外科医生之间的咨询应顺畅。
