Standardized clinical examination of maxillofacial injury: fracture diagnostic accuracy across experience levels.

Purpose: To determine whether physicians can accurately assess maxillofacial injury patients for the presence of fractures using a standardized clinical examination protocol, and to evaluate differences in assessment accuracy across experience levels.

Method: A prospective observational cohort study was conducted in four hospital emergency departments of patients with maxillofacial injuries. Physicians rated fracture probability twice on a 0-10 scale: first based on visual signs before the clinical examination, and again after the standardized clinical examination consisting of 15 midfacial or 14 mandibular parameters. The assessors were categorized as medical intern in training, junior resident, senior resident, or consultant. The patients were classified into four groups: midfacial or mandibular injury, with or without a fracture, as determined by radiographic results. The fracture probability ratings before and after the clinical examination were compared.

Results: Of 556 patients, 499 (90%) had midfacial injuries and 57 (10%) mandibular injuries. For midfacial injuries, greater variability in probability ratings and more incorrect assessments were observed compared to mandibular injuries. The intra-assessor analysis of fracture probability ratings before and after the clinical examination showed significant improvement in the direction of the eventual radiological diagnosis in three of the four patient groups for junior and senior residents, whereas the consultants, whose assessment was already proficient, only improved for one group, and none for interns. The inter-assessor analysis of fracture probability ratings showed no significant differences between the assessors.

Conclusion: Midfacial injuries are more difficult to assess than mandibular injuries, and junior and senior residents benefited the most from the standardized clinical examinations.