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Parsons MS, Policeni B, Juliano AF, Agarwal M, Benjamin ER, Burns J, Doerr T, Dubey P, Friedman ER, Gule-Monroe MK, Gutowski KA, Hagiwara M, Jain V, Rath TJ, Shian B, Surasi DS, Taheri MR, Zander D, Corey AS. ACR Appropriateness Criteria® Imaging of Facial Trauma Following Primary Survey. J Am Coll Radiol 2022; 19:S67-S86. [PMID: 35550806 DOI: 10.1016/j.jacr.2022.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 02/19/2022] [Indexed: 10/18/2022]
Abstract
Maxillofacial trauma patients comprise a significant subset of patients presenting to emergency departments. Before evaluating for facial trauma, an emergency or trauma physician must perform a primary survey to ensure patient stabilization. Following this primary survey, this document discusses the following clinical scenarios for facial trauma: tenderness to palpation or contusion or edema over frontal bone (suspected frontal bone injury); pain with upper jaw manipulation or pain overlying zygoma or zygomatic deformity or facial elongation or malocclusion or infraorbital nerve paresthesia (suspected midface injury); visible nasal deformity or palpable nasal deformity or tenderness to palpation of the nose or epistaxis (suspected nasal bone injury); and trismus or malocclusion or gingival hemorrhage or mucosal hemorrhage or loose teeth or fractured teeth or displaced teeth (suspected mandibular injury). The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
| | - Matthew S Parsons
- Mallinckrodt Institute of Radiology, Saint Louis, Missouri; Director of Neuroimaging, Barnes West County Hospital, St Louis, Missouri, 2007-present; Director of Neuroimaging, Phelps County Hospital, Rolla, Missouri, 2019-present; Emergency Department Neuroradiology Director, 2017-present; Neuroradiology Quality and Safety Officer, 2017-present; Assistant Radiology Residency Program Director, 2019-present; American Society of Head and Neck Radiology, 2011-present; American Roentgen Ray Society, 2014-present; Abstract Review Subcommittee-Neuroradiology Section 2017-present; American Society of Spine Radiology, 2015-present; Abstracts Committee 2021-2022; Co-Chair, Website Committee 2021-2022; Social Media Committee 2021-2022.
| | - Bruno Policeni
- Panel Chair, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Amy F Juliano
- Panel Vice-Chair, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts; ACR Chair NI-RADS committee; and Mass Eye and Ear Director of Research and Academic Affairs
| | - Mohit Agarwal
- Froedtert Memorial Lutheran Hospital Medical College of Wisconsin, Milwaukee, Wisconsin; and Fellowship Program Director
| | - Elizabeth R Benjamin
- Emory University, Atlanta, Georgia; American Association for the Surgery of Trauma; and Trauma Medical Director, Grady Memorial Hospital Chair, Georgia Regional Trauma Advisory Committee, Region 3, Director of Surgical Simulation, Grady Memorial Hospital
| | - Judah Burns
- Residency Program Director, Diagnostic Radiology, Montefiore Medical Center, Bronx, New York
| | - Timothy Doerr
- Ambulatory Medical Director, Department of Otolaryngology, University of Rochester Medical Center, Rochester, New York; American Academy of Otolaryngology-Head and Neck Surgery
| | - Prachi Dubey
- Houston Methodist Hospital, Houston, Texas; and Alternate Councilor, TRS and Member ACR Neuroradiology Commission
| | | | - Maria K Gule-Monroe
- Medical Director of Imaging at Woodlands Houston Area Location, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Karol A Gutowski
- University of Illinois at Chicago, Chicago, Illinois; University of Chicago, Chicago, Illinois; American Society of Plastic Surgeons
| | - Mari Hagiwara
- Neuroradiology Fellowship Program Director, New York University Langone Health, New York, New York
| | - Vikas Jain
- Assistant Program Director of Radiology Residency Program, MetroHealth Medical Center, Cleveland, Ohio
| | - Tanya J Rath
- Division Chair of Neuroradiology; Education Director of Neuroradiology, Mayo Clinic Arizona, Phoenix, Arizona; and President of the ENRS
| | - Brian Shian
- University of Iowa Carver College of Medicine, Iowa City, Iowa; Primary care physician
| | - Devaki Shilpa Surasi
- Patient Safety and Quality Officer, Department of Nuclear Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas; Commission on Nuclear Medicine and Molecular Imaging
| | - M Reza Taheri
- Director of Neuroradiology, George Washington University Hospital, Washington, District of Columbia
| | - David Zander
- Chief of Head and Neck Radiology, University of Colorado Denver, Denver, Colorado
| | - Amanda S Corey
- Specialty Chair, Atlanta VA Health Care System and Emory University, Atlanta, Georgia
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Less Operating and More Overtriage: National Trends in Interfacility Transfer of Facial Fracture Patients. Plast Reconstr Surg 2022; 149:943e-953e. [PMID: 35286290 DOI: 10.1097/prs.0000000000009039] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The purpose of this study was to characterize demographics, injury patterns, and initial management trends of facial fracture patients who were subject to interfacility transfer. METHODS Using the National Trauma Data Bank from 2007 to 2015, facial fracture patients arriving by interfacility transfer were included in the study. RESULTS Over 9 years, 171,618 patients were included, with 37.5 percent having an isolated facial injury. Isolated facial injury patients tended to be younger, less frequently white, more frequently assaulted, and more frequently underwent facial fracture operative repair during the index admission (all, p < 0.001). From 2007 to 2015, insurance coverage increased from 54.6 to 79.0 percent (R2 = 0.90, p < 0.001). In addition, there was a 45 percent proportional increase in patients 50 to 89 years of age compared to a 20 percent decrease in patients 0 to 39 years of age (both, R2 = 0.99, p < 0.001). The proportion of transfer patients with isolated facial injury increased over the study period (32.0 to 39.4 percent, R2 = 0.90, p < 0.001); however, there was a decline in operative intervention (29.5 to 22.1 percent, R2 = 0.94, p < 0.001) and a 151 percent increase in the proportion discharged from the emergency department upon transfer arrival (R2 = 0.99, p < 0.001). CONCLUSIONS Facial fracture patients subject to interfacility transfer comprise a wide array of demographics and injury patterns, with most having concomitant injuries and only a minority undergoing immediate operative intervention. Over time, this demographic has become older, sustained more isolated facial injury, and undergone fewer immediate operative interventions and is more frequently insured and more frequently discharged from the emergency department upon transfer arrival, reflecting increasing rates of secondary overtriage.
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