title: Mild traumatic brain injury diagnosis frequently remains unrecorded in subjects with craniofacial fractures.
abstract: BACKGROUND
  Traumatic brain injuries (TBI) in subjects with craniofacial fractures are usually diagnosed by emergency room physicians. We investigated how often TBI remains unrecorded in these subjects, and whether diagnostic accuracy has improved after the implementation of new TBI guidelines.
  
  
  METHODS
  All subjects with craniofacial fractures admitted to Oulu University Hospital in 1999 and in 2007 were retrospectively identified. New guidelines for improving the diagnostic accuracy of TBI were implemented between 2000 and 2006. Clinical symptoms of TBI were gathered from notes on hospital charts and compared to the recorded diagnoses at discharge. Logistic regression was used to identify independent predictors for TBI to remain unrecorded.
  
  
  RESULTS
  Of 194 subjects with craniofacial fracture, 111(57%) had TBI, 40 in 1999 and 71 in 2007. Fifty-one TBIs (46%) remained unrecorded at discharge, 48 being mild and 3 moderate-to-severe. Subjects with unrecorded TBI were significantly less frequently referred to follow-up visits. Failures to record the TBI diagnosis were less frequent (29/71, 41%) in 2007 than in 1999 (22/40, 55%), but the difference was not statistically significant. The most significant independent predictor for this failure was the clinical specialty (other than neurology/neurosurgery) of the examining physician (p<0.001). The subject's alcohol intoxication did not hamper the diagnosis of TBI.
  
  
  CONCLUSIONS
  TBIs remain frequently unrecorded in subjects with craniofacial fractures. Recording of mild TBI slightly but insignificantly improved after the implementation of new guidelines.
authors.affiliation: Department of Neurology, Oulu University Hospital, Finland. jpuljula@paju.oulu.fi
authors.forename: Jussi
authors.initials: J
authors.lastname: Puljula
authors.forename: Hanna
authors.initials: H
authors.lastname: Cygnel
authors.forename: Elina
authors.initials: E
authors.lastname: Mäkinen
authors.forename: Veli
authors.initials: V
authors.lastname: Tuomivaara
authors.forename: Vesa
authors.initials: V
authors.lastname: Karttunen
authors.forename: Ari
authors.initials: A
authors.lastname: Karttunen
authors.forename: Matti
authors.initials: M
authors.lastname: Hillbom
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000428:Alcohol Drinking / Q000009:adverse effects / Q000453:epidemiology; D001930:Brain Injuries / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D002648:Child; D005147:Facial Bones / Q000293:injuries*; D005260:Female; D005387:Finland / Q000453:epidemiology; D015600:Glasgow Coma Scale; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008337:Mandibular Fractures / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D008875:Middle Aged; D009917:Orbital Fractures / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D014057:Tomography, X-Ray Computed; D015599:Trauma Severity Indices; D055815:Young Adult