Background: Children who sustain injuries resulting in facial fractures are at risk for concomitant concussion. Prompt diagnosis and appropriate management of concussions are crucial in preventing neurocognitive impairment. The goal of this study is to examine the relationships between distinct craniofacial fracture patterns, injury mechanism, and concussion in pediatric patients. Methods: A retrospective review of 3334 patients <18 years of age who were evaluated at a pediatric level I trauma center from 2006 to 2021 for facial fractures was performed. Data collected included patient demographics, mechanism of injury, documentation of concussion, and facial fracture type. Patients with an intracranial injury were excluded. Results: Two hundred twenty-seven patients met inclusion criteria (67.9% male), mean age at injury was 12.3 ± 4.3 years. Overall, concussions were more common in children >12 years old (54.2%), with sports as the most common cause of injury (32.5%). In patients <12 years, motor vehicle accidents were the main cause of injury (30.6%, P < .001). Zygomaticomaxillary complex and maxillary fractures were associated with higher rates of concomitant concussion. Patients with a history of prior concussion were 3.4 times more likely to present with another concussion (odds ratio, 3.4; 95% Cl, 1.7-6.9). Conclusions: Nearly 7% of pediatric patients with facial fractures in this retrospective series were diagnosed with a concomitant concussion. The results suggest that a higher index of suspicion for concussions should be maintained for patients with midface fractures and those with a previous history of concussions.

Background: Treatment of facial fractures in pediatric patients requiring intensive care unit (ICU) care has not been well categorized. The purpose of this study is to describe a single-institution experience with the management of pediatric facial fractures in patients requiring ICU-level care. Methods: We performed a retrospective review of patients under 18 years old who presented to a level I trauma center with facial fractures between 2006 and 2021. Types of facial fractures, mechanisms of injury, operative treatment, GCS score, and associated injuries were evaluated in ICU patients compared to patients who were admitted to the hospital, but not ICU. Results: Facial fractures were diagnosed in 3334 patients. Of them, 1080 were admitted to the hospital and 207 patients (19.2%) required ICU-level care. Among these patients, the average age was 9.7 ± 4.9 years. The average length of stay was 9.2 ± 10.9 days and the average lowest GCS score was 10.3 ± 4.6. The most common mechanism of injury was a motor vehicle accident (n = 122, 59.5%). Compared to non-ICU admitted patients, patients admitted to the ICU were significantly more likely to present with skull (n = 124, 60.5%, P < .001), orbital (n = 140, 68.3%, P < .001), and maxillary fractures (n = 96, 46.8%, P < .001) and significantly less likely to present with mandibular fractures (n = 47, 22.9%, P = .020). ICU patients had significantly more associated injuries, particularly neurological injuries (91.2% vs 47.8%, P < .001). ICU patients underwent operative treatment at the same rate as non-ICU admitted patients (OR, 0.7 [95% CI, 0.5-1.0]). Conclusions: Pediatric facial fracture patients requiring ICU-level care are a poorly characterized population. Our data suggest that high impact mechanisms of injury and specific fracture patterns are associated with ICU admission as these patients require particular attention and management.

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