title: Facial Fracture in the Setting of Whole-Body CT for Trauma: Incidence and Clinical Predictors.
abstract: OBJECTIVE
  The objective of our study was to identify the incidence and clinical predictors of facial fracture in the setting of whole-body MDCT for trauma.
  
  
  METHODS
  The clinical data from the electronic medical records, including the final radiology reports, of 486 consecutive patients who underwent MDCT for trauma (head, cervical spine, chest, abdomen, and pelvis examinations) with dedicated maxillofacial reconstructions from October 1, 2011, to July 31, 2013, were studied. The clinical variables were compared between cohorts of patients with and those without facial fracture. The two-sample t test was used to compare continuous variables, and the Fisher exact test was used to compare categoric variables.
  
  
  RESULTS
  Two hundred sixteen (44.4%) patients had at least one fracture on the dedicated maxillofacial CT examinations, 215 of whom had facial physical examination findings (sensitivity = 99.5%). Of the 28 patients without documented physical examination findings, 27 did not have a facial fracture (negative predictive value = 96.4%). Statistically significant differences were found between positive and negative cases of facial fracture in patients with a Glasgow coma scale (GCS) score of 8 or less (p < 0.0001), an injury severity score of 16 or greater (p < 0.0001), acute alcohol intoxication according to blood alcohol concentration (BAC) (p = 0.0387), intubation at presentation (p < 0.0001), positive physical examination findings (p < 0.0001), and loss of consciousness (p = 0.0364). Falls from a height greater than standing height and open-vehicle collisions had the highest fracture rates (80.0% and 58.3%, respectively).
  
  
  CONCLUSIONS
  A negative finding at facial physical examination reliably excluded fracture. Clinical variables positively associated with facial fracture included the following: GCS score of 8 or less, ISS of 16 or greater, alcohol intoxication according to BAC, intubation at presentation, loss of consciousness, and the presence of abnormal facial findings at physical examination.
authors.affiliation: 1 Department of Radiology and Imaging Sciences, Division of Emergency Radiology, Indiana University School of Medicine, Indianapolis, IN.|2 Present address: Department of Radiology, Division of Emergency Imaging, Massachusetts General Hospital, 55 Fruit St, FND-210, Boston, MA 02114.
authors.forename: Ryan T
authors.initials: RT
authors.lastname: Whitesell
authors.affiliation: 1 Department of Radiology and Imaging Sciences, Division of Emergency Radiology, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Scott D
authors.initials: SD
authors.lastname: Steenburg
authors.affiliation: 3 Department of Biostatistics, School of Medicine and Richard M. Fairbanks School of Public Health, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Changyu
authors.initials: C
authors.lastname: Shen
authors.affiliation: 3 Department of Biostatistics, School of Medicine and Richard M. Fairbanks School of Public Health, Indiana University School of Medicine, Indianapolis, IN.
authors.forename: Hongbo
authors.initials: H
authors.lastname: Lin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005151:Facial Injuries / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D015994:Incidence; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012887:Skull Fractures / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000209:etiology; D014057:Tomography, X-Ray Computed / Q000379:methods*; D051598:Whole Body Imaging
keywords: MDCT; emergency; maxillofacial; trauma