Application of a Facial Injury Severity Scale in Craniomaxillofacial Trauma
Purpose
To establish a Facial Injury Severity Scale (FISS) that correlates with patient outcome and provides a practical tool for communication between clinicians and healthcare personnel for management of facial trauma.
Patients and Methods
All patients presenting to the Emergency Department (ED) at Legacy Emanuel Hospital (Level One Trauma Center) in Portland, Oregon between 01/1993 and 6/2003 with facial fractures with or without concomitant non-facial injuries where identified retrospectively. The diagnosis and treatment of all facial fractures were conducted by the Oral and Maxillofacial Surgery (OMFS) service. The following data were collected; age, gender, mechanism of injury, detailed diagnosis of facial fractures, disposition, and the length of hospital stay (LOS). The hospital operating room charges (ORC) for the treatment of each patient’s facial fractures were also obtained. We designed the FISS to be a numeric value composed of the sum of the individual fractures and fracture patterns in a patient. Not all fractures of the face are weighted equally in the FISS because not all fracture patterns are equal in severity. Individual fracture points within the scale were optimized to result in the highest correlation.
Results
A total of 1,115 patient admissions to the ED with blunt or penetrating maxillofacial injuries were identified and reviewed. Full information on operating room charges (ORC) was available for 247 patients (average age: 32, SD ± 17; range, 2 to 84; male:female, 3:1; blunt:penetrating, 232:15). The FISS scores were calculated for each patient (average FISS: 4.4, SD ± 2.7; range, 1 to 13). Hospital ORC for the treatment of each patient’s maxillofacial injuries were obtained from the hospital financial services (average ORC: $4,135, SD ± $2,832; range, $845 to $18,974). A significant correlation was identified between the FISS and the ORC (R value = .82). The length of stay was significantly associated with the FISS (t = 4.7, 245 degrees of freedom, P = .000004). Although the association was statistically significant, FISS is not a very good predictor of length of stay. The correlation between the predicted and observed values was 0.38. There were 3 deaths among the 247 entries. Those 3 deaths had higher than average FISS scores, but the difference between the scores of survivors and non-survivors was not significant (P= .08). The number of deaths was small and a larger study would be required to resolve this question.
Conclusions
We introduce a FISS that is easily calculated and reliably predicts the severity of maxillofacial injuries as measured by the operating room charges required to treat the facial injury. The scale is also an indicator of hospital length of stay. We anticipate this to be a valuable tool for assessment and management of maxillofacial trauma.
⁎Formerly, Fellow in Craniomaxillofacial Trauma/Cosmetic Surgery, Head and Neck Surgical Associates; Currently, Clinical Assistant Professor of Oral and Maxillofacial Surgery, Department of Surgery, Emory University School of Medicine; and Private Practice, Atlanta, GA
†Clinical Professor, Department of Oral and Maxillofacial Surgery, Oregon Health & Science University; and Director of Fellowship in Head and Neck Surgery, Legacy Emanuel Hospital, Portland, OR
‡Formerly, Fellow in Head and Neck Surgery, Legacy Emanuel Hospital, Portland, OR; and Currently, Assistant Professor, Department of Oral and Maxillofacial Surgery, Mayo Clinic, Rochester, MN
§Chief Resident, Oral and Maxillofacial Surgery, Oregon Health & Science University, Portland, OR
∥Assistant Clinical Professor, Oregon Health & Science University; and Attending Maxillofacial Surgeon, Legacy Emanuel Hospital, Portland, OR
¶Medical Director, Clinical Investigations and Biomedical Research, Legacy Hospital Systems, Portland, OR
#Clinical Professor, Department of Oral and Maxillofacial Surgery, Oregon Health & Science University; and Director, Maxillofacial Trauma, Legacy Emanuel Hospital, Portland, OR
Address correspondence and reprint requests to Dr Bagheri: 200 Galleria Parkway, Suite 1810, Atlanta, GA 30339
ABSTRACT