title: Is a black eye a useful sign of facial fractures in patients with minor head injuries? A retrospective analysis in a level I trauma centre over 10 years.
abstract: Orbital blunt trauma is common, and the diagnosis of a fracture should be made by computed tomographic (CT) scan. However, this will expose patients to ionising radiation. Our objective was to identify clinical predictors of orbital fracture, in particular the presence of a black eye, to minimise unnecessary exposure to radiation. A 10-year retrospective study was made of the medical records of all patients with minor head trauma who presented with one or two black eyes to our emergency department between May 2000 and April 2010. Each of the patients had a CT scan, was over 16 years old, and had a Glasgow Coma Score (GCS) of 13-15. The primary outcome was whether the black eye was a valuable predictor of a fracture. Accompanying clinical signs were considered as a secondary outcome. A total of 1676 patients (mean (SD) age 51 (22) years) and minor head trauma with either one or two black eyes were included. In 1144 the CT scan showed a fracture of the maxillofacial skeleton, which gave an incidence of 68.3% in whom a black eye was the obvious symptom. Specificity for facial fractures was particularly high for other clinical signs, such as diminished skin sensation (specificity 96.4%), diplopia or occulomotility disorders (89.3%), fracture steps (99.8%), epistaxis (95.5%), subconjunctival haemorrhage (90.4%), and emphysema (99.6%). Sensitivity for the same signs ranged from 10.8% to 22.2%. The most striking fact was that 68.3% of all patients with a black eye had an underlying fracture. We therefore conclude that a CT scan should be recommended for every patient with minor head injury who presents with a black eye.
authors.affiliation: Department of Cranio-Maxillofacial Surgery, University Hospital of Bern (Inselspital), CH-3010 Bern, Switzerland. Electronic address: michael.buttner@gmail.com.
authors.forename: Michael
authors.initials: M
authors.lastname: Büttner
authors.affiliation: Department of Cranio-Maxillofacial Surgery, University Hospital of Bern (Inselspital), CH-3010 Bern, Switzerland.
authors.forename: Fabian Lukas
authors.initials: FL
authors.lastname: Schlittler
authors.affiliation: University Hospital of Child and Adolescence Psychiatry and Psychotherapy, Bolligenstrasse 111, CH-3000 Bern, Switzerland.
authors.forename: Chantal
authors.initials: C
authors.lastname: Michel
authors.affiliation: Department of Emergency Medicine, University Hospital of Bern (Inselspital), CH-3010 Bern, Switzerland.
authors.forename: Aris Konstantinos
authors.initials: AK
authors.lastname: Exadaktylos
authors.affiliation: Department of Cranio-Maxillofacial Surgery, University Hospital of Bern (Inselspital), CH-3010 Bern, Switzerland.
authors.forename: Tateyuki
authors.initials: T
authors.lastname: Iizuka
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003229:Conjunctival Diseases / Q000175:diagnosis; D004172:Diplopia / Q000175:diagnosis; D004646:Emphysema / Q000175:diagnosis; D004844:Epistaxis / Q000175:diagnosis; D005147:Facial Bones / Q000293:injuries; D005544:Forecasting; D015600:Glasgow Coma Scale; D006406:Hematoma / Q000175:diagnosis*; D006470:Hemorrhage / Q000175:diagnosis; D006801:Humans; D006987:Hypesthesia / Q000175:diagnosis; D008875:Middle Aged; D015835:Ocular Motility Disorders / Q000175:diagnosis; D009916:Orbital Diseases / Q000175:diagnosis*; D009917:Orbital Fractures / Q000175:diagnosis*; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D012887:Skull Fractures / Q000175:diagnosis; D014057:Tomography, X-Ray Computed / Q000379:methods; D014949:Wounds, Nonpenetrating / Q000175:diagnosis*; D055815:Young Adult
keywords: Black eye; Clinical predictors; Computed tomography; Orbital fractures; Retrospective study