Traumatic intracranial haemorrhage in conscious patients with facial fractures--a review of 1959 cases.
OBJECTIVE
Facial fracture patients who are conscious with a Glasgow Coma Scale (GCS) score of 15 in the absence of clinical neurological abnormalities are commonly not expected to have suffered severe intracranial pathology. However, high velocity impact may result in intracranial haemorrhage in different compartments.


METHODS
Over a 7-year period, 1959 facial fracture patients with GCS scores of 15 and the absence of neurological abnormalities were analysed. In 54 patients (2.8%) computed tomography scans revealed the presence of accompanying intracranial haemorrhage (study group). These patients were compared with the 1905 patients without intracranial haemorrhage (control group).


RESULTS
Univariate analysis identified accompanying vomiting/nausea and seizures, cervical spine injuries, cranial vault and basal skull fractures to be significantly associated with intracranial bleeding. In multivariate analysis the risk was increased nearly 25-fold if an episode of vomiting/nausea had occurred. Seizures increased the risk of bleeding more than 15-fold. The mean functional outcome of the study group according to the Glasgow Outcome Scale was 4.7+/-0.7.


CONCLUSIONS
Intracranial haemorrhage cannot be excluded in patients with facial fractures despite a GCS score of 15 and normal findings following neurological examination. Predictors, such as vomiting/nausea or seizures, skull fractures and closed head injuries, enhance the likelihood of an intracranial haemorrhage and have to be considered.
Kloss
Frank
F
Department of Cranio-Maxillofacial and Oral Surgery, Medical University of Innsbruck, Austria.
Laimer
Klaus
K
Hohlrieder
Matthias
M
Ulmer
Hanno
H
Hackl
Wolfgang
W
Benzer
Arnulf
A
Schmutzhard
Erich
E
Gassner
Robert
R
D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000203:Activities of Daily Living; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001265:Athletic Injuries / Q000453:epidemiology; D001317:Austria / Q000453:epidemiology; D016022:Case-Control Studies; D002574:Cervical Vertebrae / Q000293:injuries; D002675:Child, Preschool; D003243:Consciousness; D005147:Facial Bones / Q000293:injuries*; D005260:Female; D015600:Glasgow Coma Scale; D016489:Head Injuries, Closed / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D020198:Intracranial Hemorrhage, Traumatic / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000453:epidemiology; D009917:Orbital Fractures / Q000453:epidemiology; D012307:Risk Factors; D012640:Seizures / Q000453:epidemiology; D012887:Skull Fractures / Q000453:epidemiology*; D014839:Vomiting / Q000453:epidemiology; D055815:Young Adult; D015051:Zygomatic Fractures / Q000453:epidemiology