Traumatic optic neuropathy prediction after blunt facial trauma: derivation of a risk score based on facial CT findings at admission.
OBJECTIVE
To determine the specific facial computed tomographic (CT) findings that can be used to predict traumatic optic neuropathy (TON) in patients with blunt craniofacial trauma and propose a scoring system to identify patients at highest risk of TON.


METHODS
This study was compliant with HIPAA, and permission was obtained from the institutional review board. Facial CT examination findings in 637 consecutive patients with a history of blunt facial trauma were evaluated retrospectively. The following CT variables were evaluated: midfacial fractures, extraconal hematoma, intraconal hematoma, hematoma along the optic nerve, hematoma along the posterior globe, optic canal fracture, nerve impingement by optic canal fracture fragment, extraconal emphysema, and intraconal emphysema. A prediction model was derived by using regression analysis, followed by receiver operating characteristic analysis to assess the diagnostic performance. To examine the degree of overfitting of the prediction model, a k-fold cross-validation procedure (k = 5) was performed. The ability of the cross-validated model to allow prediction of TON was examined by comparing the mean area under the receiver operating characteristic curve (AUC) from cross-validations with that obtained from the observations used to create the model.


RESULTS
The five CT variables with significance as predictors were intraconal hematoma (odds ratio, 12.73; 95% confidence interval [CI]: 5.16, 31.42; P < .001), intraconal emphysema (odds ratio, 5.21; 95% CI: 2.03, 13.36; P = .001), optic canal fracture (odds ratio, 4.45; 95% CI: 1.91, 10.35; P = .001), hematoma along the posterior globe (odds ratio, 0.326; 95% CI: 0.111, 0.958; P = .041), and extraconal hematoma (odds ratio, 2.36; 95% CI: 1.03, 5.41; P = .042). The AUC was 0.818 (95% CI: 0.734, 0.902) for the proposed model based on the observations used to create the model and 0.812 (95% CI: 0.723, 0.9) after cross-validation, excluding substantial overfitting of the model.


CONCLUSIONS
The risk model developed may help radiologists suggest the possibility of TON and prioritize ophthalmology consults. However, future external validation of this prediction model is necessary.
From the Department of Diagnostic Radiology and Nuclear Medicine, R. Adams Cowley Shock Trauma Center (U.K.B., K.S., S.E.M.), Department of Ophthalmology and Visual Sciences (L.K., R.K.S.), and Department of Radiology (S.E.M., J.K.), University of Maryland Medical Center, 22 S Greene St, Baltimore, MD 21201; Institute of Radiology, San Matteo Medical Center, University of Pavia, Lombardy, Italy (G.V.d.B.); Department of Ophthalmology and Visual Sciences, Havener Eye Institute, Ohio State University, Columbus, Ohio (E.G.); Department of Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand (N.S.); and Bloomberg School of Public Health, The Johns Hopkins University, Baltimore, Md (K.R.S.).
Uttam K
UK
Bodanapally
Giulia
G
Van der Byl
Kathirkamanathan
K
Shanmuganathan
Lee
L
Katzman
Elena
E
Geraymovych
Nitima
N
Saksobhavivat
Stuart E
SE
Mirvis
Kuladeep R
KR
Sudini
Jaroslaw
J
Krejza
Robert Kang
RK
Shin
D000293:Adolescent; D000328:Adult; D000368:Aged; D015897:Comorbidity; D005145:Face / Q000000981:diagnostic imaging; D005151:Facial Injuries / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000000981:diagnostic imaging / Q000453:epidemiology; D020221:Optic Nerve Injuries / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D015599:Trauma Severity Indices; D014481:United States / Q000453:epidemiology; D014949:Wounds, Nonpenetrating / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D055815:Young Adult