Is a black eye a useful sign of facial fractures in patients with minor head injuries? A retrospective analysis in a level I trauma centre over 10 years
| Autor: | Aris Konstantinos Exadaktylos, Michael Büttner, Tateyuki Iizuka, Fabian Schlittler, Chantal Michel |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
Adult
medicine.medical_specialty Adolescent genetic structures Poison control Hemorrhage Wounds Nonpenetrating Sensitivity and Specificity Conjunctival Diseases Facial Bones Hypesthesia Young Adult Ocular Motility Disorders Diplopia Orbital Diseases medicine Humans Glasgow Coma Scale Orbital Fracture Orbital Fractures Aged Retrospective Studies Aged 80 and over Emphysema Hematoma Skull Fractures business.industry Retrospective cohort study Emergency department Middle Aged eye diseases Surgery Epistaxis Otorhinolaryngology Blunt trauma Oral Surgery medicine.symptom Tomography X-Ray Computed business Forecasting Black eye |
| Zdroj: | British Journal of Oral and Maxillofacial Surgery. 52:518-522 |
| ISSN: | 0266-4356 |
| DOI: | 10.1016/j.bjoms.2014.03.018 |
| Popis: | Orbital blunt trauma is common, and the diagnosis of a fracture should be made by computed tomographic (CT) scan. However, this will expose patients to ionising radiation. Our objective was to identify clinical predictors of orbital fracture, in particular the presence of a black eye, to minimise unnecessary exposure to radiation. A 10-year retrospective study was made of the medical records of all patients with minor head trauma who presented with one or two black eyes to our emergency department between May 2000 and April 2010. Each of the patients had a CT scan, was over 16 years old, and had a Glasgow Coma Score (GCS) of 13-15. The primary outcome was whether the black eye was a valuable predictor of a fracture. Accompanying clinical signs were considered as a secondary outcome. A total of 1676 patients (mean (SD) age 51 (22) years) and minor head trauma with either one or two black eyes were included. In 1144 the CT scan showed a fracture of the maxillofacial skeleton, which gave an incidence of 68.3% in whom a black eye was the obvious symptom. Specificity for facial fractures was particularly high for other clinical signs, such as diminished skin sensation (specificity 96.4%), diplopia or occulomotility disorders (89.3%), fracture steps (99.8%), epistaxis (95.5%), subconjunctival haemorrhage (90.4%), and emphysema (99.6%). Sensitivity for the same signs ranged from 10.8% to 22.2%. The most striking fact was that 68.3% of all patients with a black eye had an underlying fracture. We therefore conclude that a CT scan should be recommended for every patient with minor head injury who presents with a black eye. |
| Databáze: | OpenAIRE |
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