Relation between facial fractures and socioeconomic deprivation in the north east of England

Premorbid Incidence of Mental Health and Substance Abuse Disorders in Facial Trauma Patients

Study Design

A retrospective study.

Objective

Facial trauma is a prevalent cause of morbidity and mortality with increasing incidence over recent decades. Few studies have examined the prevalence of mental health and substance abuse disorders at the time of diagnosis. Herein we investigate the psychosocial demographics associated with facial trauma.

Methods

The 2016 State Inpatient Database (SID) was used to identify patients with facial trauma from all hospitals in New York, Florida, and Maryland. A non-trauma control group undergoing elective same-day surgeries at ambulatory surgical centers in Florida, Kentucky, Nevada, North Carolina, New York, and Maryland was identified using the State Ambulatory Surgery and Services Database (SASD) from the Healthcare Cost and Utilization Project (HCUP). 777 patients were identified with facial trauma and compared to 500 patients without facial fractures.

Results

Patients with facial fractures were statistically significantly more likely to have a substance abuse disorder (OR 34.78, P < .001) or mental health disorder (OR 2.75, P < .001) compared to controls. Patients with facial fractures were significantly more likely to be black than white (OR 4.80, P < .001). Patients with facial fractures were significantly more likely to have Medicaid compared to Medicare (OR 2.12, P = .005).

Conclusions

Patients with facial fractures are more likely to have premorbid substance abuse and mental health disorders as compared to controls.

Risk Factors for Missed Follow-up Appointments among Facial Trauma Patients

A retrospective case-control study was performed to characterize the rate of missed follow-up appointments after facial trauma and identify associated risk factors.Follow-up appointments for facial trauma over a 3-month period at a single, safety net hospital were analyzed. Appointment-specific, sociodemographic, trauma, and management data were compared between cases (missed appointments) and controls (attended appointments). Univariate testing and multivariable logistic regression were employed.A total of 116 cases and 259 controls were identified, yielding a missed appointment rate of 30.9% (116/375). Missed appointments were significantly associated with initial clinic appointments compared to return visits (odds ratio [OR] 2.21 [1.38-3.54]), afternoon visits compared to morning (OR 3.14 [1.94-5.07]), lack of private health insurance (OR 2.91 [1.68-5.18]), and presence of midface fractures (OR 2.04 [1.28-3.27]). Missed appointments were negatively associated with mandible fractures (OR 0.56 [0.35-0.89]), surgical management (OR 0.48 [0.30-0.77]), and the presence of nonremovable hardware (OR 0.39 [0.23-0.64]). Upon multivariable logistic regression, missed appointments remained independently associated with afternoon visits (adjusted OR [aOR] 1.95 [1.12-3.4]), lack of private health insurance (aOR 2.73 [1.55-4.8]), and midface fractures (aOR 2.09 [1.21-3.59]).Nearly one-third of facial trauma patients missed follow-up appointments, with the greatest risk among those with afternoon appointments, lacking private health insurance, and with midface fractures.

Changes in hospital admissions for facial fractures during and after COVID 19 pandemic: national multicentric epidemiological analysis on 2938 patients

PURPOSE

The objective of this multicenter study was to examine the differences in maxillo-facial fractures epidemiology across the various phases of the SARS-CoV-2 pandemic.

METHODS

This is a retrospective study on patients who underwent surgery for facial bone fractures in 18 maxillo-facial surgery departments in Italy, spanning from June 23, 2019, to February 23, 2022. Based on the admission date, the data were classified into four chronological periods reflecting distinct periods of restrictions in Italy: pre-pandemic, first wave, partial restrictions, and post-pandemic. Epidemiological differences across the groups were analysed.

RESULTS

The study included 2938 patients. A statistically significant difference in hospitalization causes was detected between the pre-pandemic and first wave groups (p = 0.005) and between the pre-pandemic and partial restriction groups (p = 0.002). The differences between the pre- and post-pandemic groups were instead not significant (p = 0.106). Compared to the pre-pandemic period, the number of patients of African origin was significantly higher during the first wave and the post-pandemic period. No statistically significant differences were found across the periods concerning gender, age, fracture type, treatment approach, and hospital stay duration CONCLUSIONS: The COVID-19 pandemic brought about significant changes in fracture epidemiology, influenced by the restrictive measures enforced by the government in Italy. Upon the pandemic's conclusion, the fracture epidemiology returned to the patterns observed in the pre-pandemic period.

Association Between Socioeconomic Deprivation and Orbital Trauma in a Hospital-Based Population

PURPOSE

To examine the association between area-level socioeconomic deprivation and orbital trauma among emergency ophthalmology consults.

METHODS

We conducted a cross-sectional study using 5-year Epic data for all hospital-based ophthalmology consults at the University of Maryland Medical System, and the Distressed Communities Index (DCI) data for area-level socioeconomic deprivation. We ran multivariable logistic regression models adjusting for age to compute odds ratios (OR) and 95% confidence intervals (CI) for the association between the DCI quintile 5 distressed score and orbital trauma.

RESULTS

A total of 3,811 cases of acute emergency consults were identified, of whom 750 (19.7%) had orbital trauma and 2,386 (62.6%) had other traumatic ocular emergencies. The odds of orbital trauma among people living in a distressed community were 0.59 (95% CI 0.46-0.76) times the odds for those living in a prosperous community. Among White subjects, the odds of orbital trauma for people living in a distressed community were 1.71 (95% CI 1.12-2.62) times the odds for those living in a prosperous community; among Black subjects, the OR was 0.47 (95% CI 0.30-0.75; p-interaction = 0.0001). Among women, the OR for orbital trauma among those living in a distressed community was 0.46 (95% CI 0.29-0.71); among men, the OR was 0.70 (95% CI 0.52-0.97; p-interaction = 0.03).

CONCLUSION

Overall, we found an inverse association between higher area-level socioeconomic deprivation and orbital trauma among both men and women. The association varied by race, such that there was an inverse association with higher deprivation among Black subjects in contrast to a positive association among White subjects.

Auricular Hematomas in a High-Volume Trauma Population: A Retrospective Review

Study Design

Retrospective review.

Objective

Auricular hematomas are generally associated with sports-related injuries, with studies predominantly in white populations and high neighborhood socioeconomic status (NSES) compared to our county. A previous population-based study of trauma patients in our county, Shelby County, Tennessee, shows that those who live in high vs low NSES experienced socioeconomic variation in injury. We aim to determine if differences exist in clinical management and outcomes in this population.

Methods

Patients from two hospital systems diagnosed with auricular hematomas from 2008-2023 were reviewed retrospectively. Inclusion criteria included adequate follow-up, clinical description of the hematoma, and comment on any complications or recurrence.

Results

48 patients, with a median age of 28 (range: 0-83), with the most common etiology being assault/non-accidental trauma (NAT) at 41.7%, equally distributed across all NSES (P = .30), with one sports-related injury. Facial trauma consults were associated with lower recurrence rates, 25% vs 62.5% (P = .003) and were less likely to be placed for self-pay patients (P = .019). Bolster placement resulted in lower recurrence rates, 23.3% compared to 58.3% (P = .030).

Conclusions

Higher rates of assault/NAT etiologies existed in our population, independent of NSES. Our study reiterates the importance of facial trauma consultation and bolster usage to reduce recurrence.