title: A nationwide review of the associations among cervical spine injuries, head injuries, and facial fractures.
abstract: BACKGROUND
  : Several small studies have investigated the relationship among facial fractures, c-spine injuries, and head injuries with varying results. Determining this correlation at a national level would be the first step in updating the trauma imaging protocol. The purpose of this study was to review the incidence of facial fractures, c-spine injuries, and head injuries at trauma centers across the United States.
  
  
  METHODS
  : The design was a retrospective chart review of International Classification of Disease, Ninth Revision, diagnosis and procedure codes from the National Trauma Data Bank between the years 2002 and 2006. This included data on more than 2.7 million reported traumas.
  
  
  RESULTS
  : The incidence of facial fracture was 13.5% in patients with a c-spine injury, 21.7% in patients with a head injury, and 24.0% of patients with a combined c-spine and head trauma. Head injuries were found in 40.2% of patients with a c-spine injury, 67.9% of patients with a facial fracture, and 71.5% of patients with a combined c-spine injury and facial fracture. C-spine injuries were reported in 6.7% of facial fractures, 7.0% of head injuries, and 7.8% of patients with a combined facial fracture and head injury.
  
  
  CONCLUSIONS
  : This is the largest review in history documenting these associations. Pending cost-benefit analysis, the current trauma imaging protocol may be challenged.
authors.affiliation: Divisions of Neurosurgery and Plastic Surgery, Texas A&M Health Science Center and Scott and White, Temple, Texas, USA.
authors.forename: Ryan Patrick
authors.initials: RP
authors.lastname: Mulligan
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Friedman
authors.forename: Raman Chaos
authors.initials: RC
authors.lastname: Mahabir
mesh_terms: D002574:Cervical Vertebrae / Q000293:injuries*; D006259:Craniocerebral Trauma / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D016208:Databases, Factual; D005147:Facial Bones / Q000293:injuries*; D050723:Fractures, Bone / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D038801:International Classification of Diseases; D012042:Registries; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D013124:Spinal Injuries / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D014193:Trauma Centers