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自 SARS-CoV-2 以来,颅颌面骨折的发生率和严重程度是否发生了变化?

Have Incidence and Severity of Craniomaxillofacial Fractures Changed Since SARS-CoV-2?

机构信息

Dental Student, University of Washington School of Dentistry, Seattle, WA.

Resident, University of Washington Oral and Maxillofacial Surgery, Seattle, WA.

出版信息

J Oral Maxillofac Surg. 2024 Feb;82(2):199-206. doi: 10.1016/j.joms.2023.11.011. Epub 2023 Nov 19.

Abstract

BACKGROUND

An increase in severity and a decrease in incidence of craniomaxillofacial fractures (CMFs) were identified during the first several months of the SARS-CoV-2 pandemic. It is unclear if these changes have persisted in the current timeframe.

PURPOSE

The investigators hypothesize that the incidence and severity of CMF will not return to baseline prepandemic (control) levels as the pandemic stabilizes and becomes endemic.

STUDY DESIGN, SETTING, SAMPLE: This retrospective cohort study enrolled subjects who presented to Harborview Medical Center a Level 1 trauma center for the evaluation and management of CMF. Inclusion criteria were 1) Presentation timeline 2018 through 2022, 2) CMF identified by the 10th International Classification of Disease. Exclusion criteria were: 1) Undocumented etiology of facial fracture and 2) inadequate/unclear documentation otherwise.

PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE: The predictor variable was year of injury relating to the start of the pandemic. The groups were the prepandemic (2018, 2019) and postpandemic (2020, 2021. 2022).

MAIN OUTCOME VARIABLES

The primary outcome variable was the CMF diagnosis identified using the corresponding International Classification of Disease, 10th Edition codes. The secondary outcome variables were mechanism of injury and injury severity.

COVARIATES

The covariates were age, sex, race/ethnicity, admission status, alcohol intoxication, toxicology screen, reimbursement source, abuse reported, and abuse investigated.

ANALYSES

Univariate and bivariate analyses were performed with statistical significance at P < .05.

RESULTS

The sample was composed of 5203 subjects. The annual volumes of subjects presenting with CMF were consistent over the study period (2018, 2019, 2020, 2021, 2022 n = 1018, 963, 1020, 1062, 1140, respectively). The incidence of Hispanics increased (2018, 2019, 2020, 2021, 2022: 11.1, 9.6, 12.2, 13.9, 13.2% (P < .05)) as did firearm CMF injuries (2018, 2019, 2020, 2021, 2022: 4.13, 4.98, 4.71, 7.16, 6.75% (P < .05)). The Injury Severity Score and Abbreviated Injury Scale were both lower postpandemic compared to prepandemic; mean Injury Severity Score post [18.27 ± 12.46] versus pre [19.25 ± 12.89] (P < .05), mean Abbreviated Injury Scale post [2.94 ± 1.15] versus pre [3.04 ± 1.14] (P < .05).

CONCLUSIONS AND RELEVANCE

While the severity of CMF decreased postpandemic, Hispanic and firearm CMF increased. The overall CMF incidence remained the same. The significant rise in firearm injuries warrants further study.

摘要

背景

在 SARS-CoV-2 大流行的最初几个月,发现颅面骨折(CMF)的严重程度增加,发生率降低。目前尚不清楚这些变化是否在当前时期持续存在。

目的

研究人员假设,随着大流行的稳定和成为地方病,CMF 的发生率和严重程度不会恢复到大流行前(对照)水平。

研究设计、地点、样本:这项回顾性队列研究纳入了在 1 级创伤中心接受 CMF 评估和管理的 Harborview 医疗中心就诊的受试者。纳入标准为:1)2018 年至 2022 年的就诊时间线;2)通过第 10 次国际疾病分类确定的 CMF。排除标准为:1)面部骨折的病因未记录在案和 2)否则记录不完整/不清楚。

预测因子/暴露/自变量:预测变量是与大流行开始相关的受伤年份。组为大流行前(2018 年、2019 年)和大流行后(2020 年、2021 年、2022 年)。

主要结局变量

主要结局变量是使用相应的国际疾病分类第 10 版代码确定的 CMF 诊断。次要结局变量为损伤机制和损伤严重程度。

协变量

协变量为年龄、性别、种族/民族、入院状态、酒精中毒、毒理学筛查、报销来源、报告的滥用和调查的滥用。

分析

采用单变量和双变量分析,统计显著性水平为 P <.05。

结果

该样本由 5203 名受试者组成。研究期间(2018 年、2019 年、2020 年、2021 年、2022 年),出现 CMF 的受试者人数每年均保持一致(分别为 1018、963、1020、1062、1140)。西班牙裔人口的发病率增加(2018 年、2019 年、2020 年、2021 年、2022 年:11.1%、9.6%、12.2%、13.9%、13.2%(P <.05)),火器所致 CMF 损伤也增加(2018 年、2019 年、2020 年、2021 年、2022 年:4.13%、4.98%、4.71%、7.16%、6.75%(P <.05))。与大流行前相比,大流行后患者的损伤严重程度评分和简明损伤分级均较低;平均损伤严重程度评分后 [18.27 ± 12.46] 与前 [19.25 ± 12.89](P <.05),平均简明损伤分级后 [2.94 ± 1.15] 与前 [3.04 ± 1.14](P <.05)。

结论和相关性

尽管大流行后 CMF 的严重程度降低,但西班牙裔和火器所致 CMF 增加。总体 CMF 发病率保持不变。火器损伤的显著增加需要进一步研究。

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