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Rahimpour A, Baxter J, Giangrosso G, Murphy A, Bown P, Denning DA, Ray P, Rahman B. Age-Related Patterns of Traumatic Facial Fractures in the Appalachian Tri-state Area: A Five-Year Retrospective Study. Cureus 2024; 16:e62090. [PMID: 38989341 PMCID: PMC11236472 DOI: 10.7759/cureus.62090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2024] [Indexed: 07/12/2024] Open
Abstract
Introduction Traumatic facial injuries, leading to facial fractures represent a significant subset of traumatic events, with age emerging as a crucial determinant influencing both their etiology and outcomes. Understanding the age-related patterns of traumatic facial fractures is essential for developing targeted prevention and management strategies. In this context, the Appalachian tri-state area stands as an underexplored region concerning this issue, necessitating comprehensive research to elucidate the nuances of age-related traumatic facial fractures within this geographic context. Methods This retrospective study delves into the age-related patterns of traumatic facial fractures within the Appalachian tri-state area, drawing upon patient records from Cabell Huntington Hospital and Saint Mary's Medical Center spanning a five-year period. The study cohort encompasses 623 patients categorized into three age groups: individuals aged <22 years, those aged 22-65 years, and individuals over 65 years. Data analysis involves meticulous examination of mechanisms of injury, injury severity scores (ISSs), hospital length of stay, and the prevalence of surgical interventions across different age cohorts. Results Out of 623 patients, 104 (16.7%) were under 22 years old, 367 (58.9%) were between 22 and 65 years old, and 152 (24.4%) were over 65 years old. The majority were male (70%). Falls were the most common cause of facial fractures in patients over 65 (78%), while assaults were predominant in the 22-65 age group (24%), and motor vehicle collisions (MCVs) in those under 22 (34%). The median ISS and hospital stay durations were similar across age groups. 28% of patients underwent surgery, with significant variation among age groups (p<0.001): 38% for <22 years, 33% for 22-65 years, and 11% for >65 years. Mandibular fractures were more prevalent in younger patients, with rates of 12% for <22 years compared to 5.3% for >65 years. Logistic regression analysis revealed that patients aged 22-65 had 4.10 times higher odds (95% CI=2.38, 7.45, p<0.001) of undergoing surgery, while those under 22 had 5.14 times higher odds (95% CI=2.73, 10.0, p<0.001) compared to those over 65. Significant associations were found for mandibular and bilateral mandibular outcomes in patients aged 22-65 years. Discussion These findings underscore the imperative for tailored prevention strategies and age-specific treatment protocols to optimize patient outcomes. Fall prevention initiatives for the elderly and interventions addressing sports-related injuries for younger individuals are paramount. Moreover, the study highlights the necessity of specialized care protocols for elderly patients to minimize hospital stay durations and manage age-related comorbidities effectively. Moving forward, further research should address limitations, validate findings, and explore the efficacy of specific interventions, thereby paving the way for enhanced preventive measures and management strategies tailored to the diverse age cohorts affected by traumatic facial fractures in the Appalachian region.
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Affiliation(s)
- Armein Rahimpour
- General Surgery, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Jacy Baxter
- General Surgery, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Gerard Giangrosso
- General Surgery, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Abigail Murphy
- General Surgery, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Paul Bown
- General Surgery, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - David A Denning
- General Surgery, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Peter Ray
- Plastic and Reconstructive Surgery, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
| | - Barry Rahman
- Plastic and Reconstructive Surgery, Marshall University Joan C. Edwards School of Medicine, Huntington, USA
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Nakao S, Katayama Y, Kitamura T, Hirose T, Tachino J, Ishida K, Ojima M, Kiguchi T, Umemura Y, Kiyohara K, Oda J. Trends and characteristics of severe road traffic injuries in children: a nationwide cohort study in Japan. Eur J Trauma Emerg Surg 2023:10.1007/s00068-023-02372-z. [PMID: 37847398 DOI: 10.1007/s00068-023-02372-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 09/12/2023] [Indexed: 10/18/2023]
Abstract
PURPOSE The purpose of this study was to evaluate temporal trends of characteristics of severe road traffic injuries in children and identify factors associated with mortality using a nationwide database in Japan. METHODS We performed a retrospective analysis of Japan Trauma Data Bank (JTDB) from 2004 to 2018. We included patients with traffic injuries under the age of 18 who were hospitalized. The primary outcome was in-hospital mortality. We evaluated trends in characteristics and assessed factors associated with in-hospital mortality using a logistic regression analysis. RESULTS A total of 4706 patients were analyzed. The most common mechanism of injury was bicycle crash (34.4%), followed by pedestrian (28.3%), and motorcycle crash (21.3%). The overall in-hospital mortality was 11.2%. We found decreasing trends in motorcycle crash and in-hospital mortality and increasing trends in rear passenger seats in cars over the 15-year period. The following factors were associated with in-hospital mortality: car crash (aOR 1.69, 95%CI 1.18-2.40), pedestrian (aOR 1.50, 95%CI 1.13-1.99), motorcycle crash (aOR 1.42, 95%CI 1.03-1.95) [bicycle crash as a reference]; concomitant injuries to head/neck (aOR 5.06, 95%CI 3.81-6.79), thorax (aOR 2.34, 95%CI 1.92-2.87), abdomen (aOR 1.74, 95%CI 1.29-2.33), pelvis/lower-extremity (aOR 1.57, 95%CI 1.23-2.00), spine (aOR 3.01, 95%CI 2.02-4.43); and 5-year increase in time period (aOR 0.80, 95%CI 0.70-0.91). CONCLUSIONS We found decreasing trends in motorcycle crash and in-hospital mortality, increasing trends in rear passenger seats in cars over the 15-year period, and factors associated with in-hospital mortality such as type of mechanisms and concomitant injuries. Strengthening child road safety measures, particularly for rear passenger seats in vehicles, is imperative to enhance our dedication to injury prevention.
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Affiliation(s)
- Shunichiro Nakao
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Yusuke Katayama
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Tetsuhisa Kitamura
- Department of Social and Environmental Medicine, Division of Environmental Medicine and Population Sciences, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tomoya Hirose
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Jotaro Tachino
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Kenichiro Ishida
- Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Masahiro Ojima
- Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Takeyuki Kiguchi
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan
| | - Yutaka Umemura
- Division of Trauma and Surgical Critical Care, Osaka General Medical Center, Osaka, Japan
| | - Kosuke Kiyohara
- Department of Food Science, Faculty of Home Economics, Otsuma Women's University, Tokyo, Japan
| | - Jun Oda
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
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Fukushima K, Kambe M, Aramaki Y, Ichikawa Y, Isshiki Y, Nakajima J, Sawada Y, Oshima K. Evaluation of injury threshold from the number of rib fracture for predicting pulmonary injuries in blunt chest trauma. Heliyon 2023; 9:e15278. [PMID: 37095910 PMCID: PMC10121455 DOI: 10.1016/j.heliyon.2023.e15278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/26/2023] Open
Abstract
Background Blunt chest trauma is a common presentation in emergency departments. The relationship between bone fractures and organ injuries has not been studied in detail. The purpose of this study was to examine the degree of external force represented by the number of rib fractures that causes lung injury in blunt chest trauma. Patients and methods This study was performed retrospectively using trauma patients who received medical examinations in a single university hospital emergency center between April 2015 and March 2020. We examined the association between the number of rib fractures and pulmonary damage using multivariable regression analysis and considered the relationship between rib fracture location and each type of lung injury. Results A total of 317 patients were included. The mean age was 63.1 years, 65.0% were male, and traffic accidents were the most common mechanism of injury (55.8%). The number of mean rib fractures was 4.0, and the mean Injury Severity Score was 11.3. The number of rib fractures was associated with an increased risk of pulmonary injuries: pulmonary contusion (odds ratio [OR] 1.30, 95% confidence interval [CI] 1.14-1.48, p < 0.05); hemothorax (OR 1.22, 95% CI 1.08-1.38, p < 0.05); pneumothorax (OR 1.15, 95% CI 1.02-1.30, p < 0.05); and hemopneumothorax (OR 1.14, 95% CI 1.01-1.28, p < 0.05). In addition, bilateral rib fractures were associated with fractures of the superior ribs more often and more severely, but were not associated with the occurrence of each type of lung injury. Conclusion The number of rib fractures was associated with an increased risk of pulmonary injuries. In addition, the type of pulmonary injury could be predicted from the number of rib fractures in blunt chest trauma.
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Affiliation(s)
- Kazunori Fukushima
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Masahiko Kambe
- ER General Medical Center, Saitama Sekishinkai Hospital, Sayama, Saitama, Japan
| | - Yuto Aramaki
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yumi Ichikawa
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yuta Isshiki
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Jun Nakajima
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Yusuke Sawada
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Kiyohiro Oshima
- Department of Emergency Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
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