Traumatic intracranial hemorrhages in facial fracture patients: review of 2,195 patients.
OBJECTIVE
Patients sustaining facial fractures are at risk for accompanying traumatic intracranial hematomas, which are a major cause of morbidity and mortality. Prompt recognition is crucial in improving patient survival and recovery. This study examined which simple clinical signs identify facial fracture patients at risk for intracranial hemorrhage before the performance of computed tomography.


METHODS
Retrospective study of 2,195 patients with facial fractures during a period of 7 years. By means of univariate and multivariate analysis clinical features potentially predictive for (a) intracranial hemorrhage and (b) surgery for intracranial hemorrhage were identified.


METHODS
Critical care units of anesthesiology and neurology, general traumatology, and oral and maxillofacial surgery in a level I trauma university hospital.


RESULTS
Seizures (OR 22.1) and vomiting/nausea (OR 20.2) were the strongest independent predictors of intracranial bleeding in facial fracture patients. For intracranial hemorrhages requiring surgical intervention closed head injuries (OR 9.75) and cranial vault fractures (OR 5.0) were the most significant risk factors. However, among those patients without vomiting/nausea and without seizures and without closed head injury ( n=1,628), 20 patients (1.2%) suffered intracranial hemorrhage, and six (0.37%) of them required surgical intervention.


CONCLUSIONS
Simple clinical symptoms, such as seizures, vomiting/nausea, history of a closed head injury or cranial vault fractures are strong predictors for intracranial hemorrhage in facial fracture patients. The early consideration of such important indicators allows us to detect patients at elevated risk of an intracranial hematoma requiring surgical intervention.
Hohlrieder
Matthias
M
Department of Anesthesiology and Critical Care Medicine, University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria. matthias.hohlrieder@uibk.ac.at
Hinterhoelzl
Josef
J
Ulmer
Hanno
H
Lang
Christiane
C
Hackl
Wolfgang
W
Kampfl
Andreas
A
Benzer
Arnulf
A
Schmutzhard
Erich
E
Gassner
Robert
R
D005147:Facial Bones / Q000293:injuries*; D005260:Female; D050723:Fractures, Bone / Q000150:complications*; D006801:Humans; D020198:Intracranial Hemorrhage, Traumatic / Q000209:etiology*; D008297:Male