title: Traumatic Facial Injuries Among Elderly Nursing Home Residents: Never Event or Frequent Occurrence?
abstract: As the nursing home population continues to increase, an understanding of preventable injuries becomes exceedingly important. Although other fall-related injuries have been characterized, little attention has been dedicated to facial trauma.
  
  
  
  To estimate the incidence of facial trauma among nursing home residents and detail mechanisms of injury, injury characteristics, and patient demographic data.
  
  
  
  The National Electronic Injury Surveillance System was used to calculate a weighted national incidence of facial trauma among individuals older than 60 years from a nationally representative collection of emergency departments from January 1, 2011, through December 31, 2015. Entries were screened for nursing home residents, and diagnosis, anatomical site, demographic data, and mechanism of injury were analyzed.
  
  
  
  There were 109 795 nursing home residents (median age, 84.1 years; interquartile range, 79-89 years; 71 466 women [65.1%]) who required emergency department care for facial trauma. Women sustained a greater proportion of injuries with increasing age. The most common injuries were lacerations (48 679 [44.3%]), other soft-tissue injuries (45 911 [41.8%]; avulsions, contusions, and hematomas), and fractures (13 814 [12.6%]). Nasal (9331 [67.5%]) and orbital (1144 [8.3%]) fractures were the most common sites. The most common injury causes were direct contact with structural housing elements or fixed items (62 604 [57.0%]) and transfer to and from bed (24 870 [22.6%]).
  
  
  
  Despite falls being considered a Centers for Medicare & Medicaid Services preventable never event in hospitals, our analysis in the nursing home setting found more than 100 000 facial injuries during 5 years, suggesting these underappreciated injuries contribute substantially to health care expenditures. Although structural elements facilitated the greatest number of falls, transfer to and from bed remains a significant mechanism, suggesting an area for intervention.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Michael
authors.initials: M
authors.lastname: Bobian
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Nour
authors.initials: N
authors.lastname: El-Kashlan
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Curtis J
authors.initials: CJ
authors.lastname: Hanba
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Svider
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan2Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Folbe
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Rutgers New Jersey Medical School, Newark4Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey5Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Newark, New Jersey6Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark.
authors.forename: Jean Anderson
authors.initials: JA
authors.lastname: Eloy
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan7Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan8Division of Otolaryngology, John Dingell Veterans Affairs Medical Center, Detroit, Michigan.
authors.forename: Giancarlo F
authors.initials: GF
authors.lastname: Zuliani
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan7Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan8Division of Otolaryngology, John Dingell Veterans Affairs Medical Center, Detroit, Michigan.
authors.forename: Michael
authors.initials: M
authors.lastname: Carron
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005151:Facial Injuries / Q000453:epidemiology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes; D011159:Population Surveillance; D014481:United States / Q000453:epidemiology