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The effectiveness of protective devices in the prevention of pediatric traumatic facial fractures
Tiffany Zens, MD1, Charles Leys, MD, MSCI1, Andrew Rogers, MD1, Ying Shan2, Scott Chaiet, MD, MBA3. 1Division of Pediatric Surgery, Department of Surgery, University Of Wisconsin School of Medicine and Public Health, Madison, WI, USA, 2Department of Surgery, University Of Wisconsin School of Medicine and Public Health, Madison, WI, USA, 3Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University Of Wisconsin School of Medicine and Public Health, Madison, WI, USA.

Background: Pediatric traumatic facial fractures result in significant morbidity.

Methods: An analysis of the 2007-2012 National Trauma Data Bank was conducted. ICD-9 codes identified children suffering from facial fractures. Demographics data and outcomes measures were determined for groups based on developmental age. Using a logistic regression model, odds ratios (OR) were calculated to determine the effectiveness of protective devices such as safety belts after motor vehicle collision (MVC), and helmets after motorcycle, ATV and bicycle accidents.

Results: 51,251 children with facial fractures were included in the analysis. 68.5% were older than 13 years and 4% were <1 year. The most common mechanism of injury was MVC, except in children <1 year where falls were most common. Children >8 years were most likely to undergo operative repair during initial hospitalization. Mortality ranged from 2.1-4.7% and was highest in children <1 year. 27.4% of children had associated traumatic brain injury, with concussion, subdural and subarachnoid hemorrhage being the most common. Children with facial fractures who were not in car/booster seats (OR 1.66, CI 1.06-2.58) or using seat belts (OR 1.32, CI 1.06-1.64) were more likely to die than children using safety belts. When evaluating the age group most likely to have facial fractures from bicycle and ATV accidents (4-15 years), children without helmets (OR 1.28, CI 1.19-1.39) were more likely to have facial fractures.

Conclusions: Although accounting for only 6.9% of pediatric traumas, facial fractures carry significant morbidity. Protective devices are effective in reducing incidence of facial fractures and associated mortality.


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