title: Changing trends in adult facial trauma epidemiology.
abstract: OBJECTIVE
  The aim of this study was to determine whether the incidence of facial fractures has changed in the United States since 1990.
  
  
  METHODS
  This study is a retrospective review of all nonpediatric inpatient and outpatient facilities of the Detroit Medical Center from 1990 to 2011 and weighted national inpatient estimates from 1993 to 2010 using the National Inpatient Survey.
  
  
  METHODS
  Facial fractures and surgical repairs were grouped according to fracture site and scaled to annual populations. Chow testing determined the year with the most significant change in trend, and regressions were performed before and after the break point.
  
  
  RESULTS
  Chow testing showed the year 2000 as the most significant break point across all data sets. National inpatient and institutional data showed a significant decrease in total fractures and most subsites during the 1990s and an increase since 2000. Since 1990, the rate of fracture repairs decreased at our institution and during inpatient stays in the United States. Motor vehicle-related injuries have decreased since the early 1990s. Assault rates have fallen nationally but increased slightly in Detroit.
  
  
  CONCLUSIONS
  Evidence from the largest institutional series of adult facial fractures and the largest national inpatient database supports a decrease in fractures and repairs during the 1990s and an increase in fractures despite no change in repairs since 2000. These trends are likely related to increasing use of computed tomographic imaging, decreasing severity of facial injuries, and changing incidences of the major etiologies of facial fractures.
authors.affiliation: From the *Department of Otolaryngology-Head and Neck Surgery, School of Medicine, and †Department of Mathematics, Wayne State University, Detroit, Michigan.
authors.forename: Zachary P
authors.initials: ZP
authors.lastname: VandeGriend
authors.forename: Araz
authors.initials: A
authors.lastname: Hashemi
authors.forename: Mahdi
authors.initials: M
authors.lastname: Shkoukani
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data; D000328:Adult; D005147:Facial Bones / Q000293:injuries*; D005151:Facial Injuries / Q000453:epidemiology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008337:Mandibular Fractures / Q000453:epidemiology; D008440:Maxillary Fractures / Q000453:epidemiology; D008824:Michigan / Q000453:epidemiology; D009295:Nasal Bone / Q000293:injuries; D009917:Orbital Fractures / Q000453:epidemiology; D019651:Plastic Surgery Procedures / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012887:Skull Fractures / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D014754:Violence / Q000706:statistics & numerical data; D015051:Zygomatic Fractures / Q000453:epidemiology