Clinical And Radiographic Predictors Of The Need For Facial Ct In Pediatric Blunt Trauma: A Multi-institutional Study
Brittany Nguyen1, *Mary J Edwards1, Shachi Srivatsa1, *Derek Wakeman2, Brittany Cantor3, Thais Calderon2, *Abdularouf Lamoshi4, *Kim Wallenstein5, Mitchell Chess2, Tiffany Fabiano6, Richard Thomas6, *Kathryn Bass6
1Albany Medical Center, Albany, NY;2University of Rochester Medical Center, Rochester, NY;3John R Oishei Children's Hospital, Bufflao, NY;4Cohen Children's Medical Center, Queen's, NY;5SUNY Upstate Medical Center, Syracuse, NY;6John R. Oishei Children's Hospital, Buffalo, NY
Background (issue): Facial Injuries are common in children with blunt trauma. Most are soft tissue lacerations and dental injuries readily apparent on clinical exam. Fractures requiring operative intervention are rare. Guidelines for utilization of maxillofacial CT in children are lacking. We hypothesized that head CT would be a sensitive study for surgically significant non-mandibular facial fractures in children.
Methods: We conducted a multi-center retrospective review of children under age 18 with blunt facial injury who underwent both CT of the face and head from 2007 through 2018 at 5 pediatric trauma centers. Fractures of the mandible and dental injuries were excluded from sensitivity analysis.
Findings: 291 children with facial injury were identified. Facial CT was superior to head CT in characterization of all facial fractures. However, for all facial injuries requiring intervention other than laceration repair, head CT was able to identify a fracture (100% sensitive for clinically significant maxillofacial fractures). Minimally displaced nasal fractures, mandibular fractures and dental injuries were the most common facial fractures not identified on head CT.
Conclusions (implications for practice): In pediatric blunt trauma, head CT highly sensitive and an excellent screening tool for facial fracture. In the absence of clinical evidence of a mandibular or dental injury, a normal head CT is sufficient to rule out a clinically significant facial fracture.
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