Predicting orbital fractures in head injury: a preliminary study of clinical findings

Lookup NU author(s): James AllisonORCiD

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).

Abstract

Purpose Patients presenting to emergency departments (EDs) following head injury often undergo computed tomography (CT) of the head to exclude traumatic brain injury. In many cases this does not show the maxillofacial skeleton. A proportion of these patients also sustain facial fractures, and when fractures involve the orbits, CT imaging is useful in diagnosis and management; obtaining a second scan may cause delay, incur greater cost and increase radiation dose. The aim of this preliminary study was to examine the value of signs and symptoms of orbital fractures in predicting a fracture on CT. Methods The clinical records of 47 patients who underwent CT of the face following facial trauma were retrospectively examined for the presence of signs and symptoms of orbital fractures. Sensitivity, specificity, negative predictive value (NPV) and positive predictive values (PPV) were then calculated for each sign and symptom for the presence of an orbital fracture on CT. We also describe a clinical decision instrument and examined the predictive values of this. Results Change in the position of the globe, reduced visual acuity, subconjunctival haemorrhage and change in sensation in the maxillary division of the trigeminal nerve were the most specific signs and symptoms for orbital fracture. Our clinical decision instrument had 80.0% sensitivity, 75.0% specificity, 90.3% PPV and 56.3% NPV for predicting the presence of an orbital fracture on CT in this population. Conclusions Our results demonstrate that signs and symptoms of orbital fractures may be useful for predicting these injuries, and a decision instrument could be used in the ED to identify patients likely to benefit from extending the radiation field to include the orbits where CT of the head is already planned. This work is however exploratory, and further prospective validation is required before a robust instrument can be recommended for clinical use.

Publication metadata

Author(s): Allison JR, Kearns A, Banks RJ

Publication type: Article

Publication status: Published

Journal: Emergency Radiology: A Journal of Practical Imaging

Year: 2020

Volume: 27

Issue: 1

Pages: 31-36

Print publication date: 01/02/2020

Online publication date: 30/08/2019

Acceptance date: 13/08/2019

Date deposited: 14/08/2019

ISSN (print): 1070-3004

ISSN (electronic): 1438-1435

Publisher: Springer

URL:

DOI: 10.1007/s10140-019-01720-0

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