Computed tomography of the head as a screening examination for facial fractures

• Published in: The American journal of emergency medicine Vol. 25; no. 6; pp. 616 - 619
• Main Authors: Marinaro, Jon, MD, Crandall, Cameron S., MD, Doezema, David, MD
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Elsevier Inc 01.07.2007; Elsevier; Elsevier Limited
• Subjects: Adult; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Child; Computed tomography; Confidence intervals; Emergency; Emergency medical care; Facial Bones - diagnostic imaging; Facial Bones - injuries; Female; Humans; Injuries of the limb. Injuries of the spine; Intensive care medicine; Investigative techniques, diagnostic techniques (general aspects); Male; Medical imaging; Medical sciences; Medicare; Methods; Predictive Value of Tests; Radiodiagnosis. Nmr imagery. Nmr spectrometry; Radiography; Reading; Respiratory system; Retrospective Studies; Sensitivity and Specificity; Sinuses; Skull Fractures - diagnostic imaging; Tomography, X-Ray Computed; Trauma; Traumas. Diseases due to physical agents; Intensive care; Head; Diseases of the osteoarticular system; Fracture; Computerized axial tomography; Medical screening; Trauma; Resuscitation
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2006.11.029

Abstract We hypothesized that head computed tomography (CT) is an accurate screening tool for detecting nonnasal midfacial fractures in trauma patients. We retrospectively reviewed charts and official readings for all patients who underwent both head and facial CT scans for trauma at our trauma center between August 2002 and April 2003. The ability of head CT to diagnose nonnasal bone midfacial fractures was compared with that of facial CT using sensitivity, specificity, accuracy, as well as positive and negative predictive values. Agreement was measured with κ statistics. Ninety-five percent confidence intervals (CIs) were used to assess precision. Ninety-one patient records with head and facial CT scan reports were reviewed. Of the patients, 50 (55%) had nonnasal bone midfacial fractures. The sensitivity and specificity of head CT were 90% (95% CI = 79%-96%) and 95% (95% CI = 84%-99%), respectively; the positive and negative predictive values were 96% (95% CI = 86%-99%) and 89% (95% CI = 76%-95%), respectively. The rate of accuracy was 92%. The agreement was excellent ( κ = 0.85, 95% CI = 0.74-0.96). Head CT was sensitive and specific for identifying nonnasal bone midfacial fractures. An initial head CT alone may limit the need for a Waters view radiography or screening facial CT in detecting injuries.