Traumatic brain injury in patients with facial fracture - A challenge for the clinician?

IF 2.2 3区医学 Q2 Dentistry

Journal of Stomatology Oral and Maxillofacial Surgery Pub Date : 2025-02-21 DOI:10.1016/j.jormas.2025.102302

L Kokko, T Puolakkainen, H Thorén, A Piippo-Karjalainen, A L Suominen, J Snäll

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引用次数: 0

Abstract

Objective: This study aimed to evaluate the occurrence and clinical predictors for missed traumatic brain injury (TBI) diagnosis at primary evaluation in facial fracture patients. The specific aim was to compare the risk between adults and elderly patients.

Materials and methods: A retrospective study was performed, and data were collected from medical records. All adult facial fracture patients with associated TBI and a primary Glasgow Coma Scale score of 13 or more diagnosed and treated between 2013 and 2018 were included. The elderly group comprised patients aged at least 65 years at the time of injury.

Results: Altogether 253 patients with facial fracture and associated TBI were assessed. In 7.1 % of the cases, the diagnosis of TBI was missed in primary evaluation and thus delayed. When the different age groups were compared, the elderly had a 2.8-fold risk of missed TBI diagnosis (95 % CI 1.1-7.2, p=.0349).

Conclusions: Facial fracture patients are at significant risk of the diagnosis of associated TBI being missed at primary evaluation. Especially elderly patients with other than high-energy trauma mechanism, such as falling on ground level, are at risk of missed TBI diagnosis. Thus, patients with facial fracture should be carefully evaluated to exclude potential TBI. Assessment should occur in trauma centres where multiprofessional evaluation of these patients is routine.

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面部骨折患者的外伤性脑损伤——对临床医生的挑战？

目的：探讨面部骨折患者初诊时外伤性脑损伤（TBI）漏诊的发生率及临床预测因素。具体目的是比较成人和老年患者之间的风险。材料和方法：回顾性研究，资料收集自医疗记录。所有在2013年至2018年间诊断和治疗的伴有TBI且原发性格拉斯哥昏迷评分为13分或以上的成人面部骨折患者均被纳入研究。老年组包括受伤时年龄在65岁以上的患者。结果：共对253例面部骨折伴TBI患者进行了评估。在7.1%的病例中，TBI的诊断在初步评估中被遗漏，从而延误。当不同年龄组进行比较时，老年人有2.8倍的TBI漏诊风险（95% CI 1.1-7.2, p= 0.0349）。结论：面部骨折患者在初步评估中有明显的漏诊相关TBI的风险。特别是非高能创伤机制的老年患者，如地面坠落，有漏诊的风险。因此，面部骨折患者应仔细评估以排除潜在的TBI。评估应在创伤中心进行，对这些患者进行多专业评估是常规的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Stomatology Oral and Maxillofacial Surgery Dentistry-Oral Surgery

CiteScore

2.20

自引率

9.10%

发文量

305

期刊介绍： J Stomatol Oral Maxillofac Surg publishes research papers and techniques - (guest) editorials, original articles, reviews, technical notes, case reports, images, letters to the editor, guidelines - dedicated to enhancing surgical expertise in all fields relevant to oral and maxillofacial surgery: from plastic and reconstructive surgery of the face, oral surgery and medicine, … to dentofacial and maxillofacial orthopedics. Original articles include clinical or laboratory investigations and clinical or equipment reports. Reviews include narrative reviews, systematic reviews and meta-analyses. All manuscripts submitted to the journal are subjected to peer review by international experts, and must: Be written in excellent English, clear and easy to understand, precise and concise; Bring new, interesting, valid information - and improve clinical care or guide future research; Be solely the work of the author(s) stated; Not have been previously published elsewhere and not be under consideration by another journal; Be in accordance with the journal''s Guide for Authors'' instructions: manuscripts that fail to comply with these rules may be returned to the authors without being reviewed. Under no circumstances does the journal guarantee publication before the editorial board makes its final decision. The journal is indexed in the main international databases and is accessible worldwide through the ScienceDirect and ClinicalKey Platforms.