Review of computed tomography imaging can decrease nontherapeutic transfer after facial trauma.

Abstract

Maxillofacial trauma encompasses a spectrum of injuries, from minor facial fractures to severe craniofacial defects, some requiring urgent surgical intervention while others are managed nonoperatively. Remote evaluation of patients by facial trauma specialists before transfer could provide an opportunity to reduce the number of nontherapeutic transfers. Our institution's trauma registry was queried for adult patients transferred from a system hospital with facial injuries. A random selection of 150 patients with computed tomography (CT) imaging available for review from the transferring facility was selected. Facial trauma surgeons then reviewed charts and CT images to determine the need for surgery, the timing of surgery, and additional clinical information needed to make this determination. The mean age was 50 years, with a median Abbreviated Injury Scale score of 2. Based on CT imaging, 27% would require surgery, 57% did not require surgery, and 16% were indeterminate and required additional clinical information. Of those who were indeterminant, 80% required an eye examination, 24% required an oral examination, and 28% required a nasal examination. Of those requiring surgery, only 7% had urgent indications in less than 24 hours. Surgery during the same admission was appropriate for 68% of patients, and 25% of patients would have been suitable for outpatient surgery. Based on CT imaging alone, the reviewers proved to have 100% accuracy in determining whether the patient was nonoperative or in need of urgent surgery. This study demonstrates that most transfers for facial fractures are low grade and nonoperative. Remote CT evaluation of patients with facial fractures could significantly decrease the incidence of nontherapeutic transfers. Therapeutic/Care Management; Level IV.