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.

This experiment aimed to (1) induce System-1-type diagnostic reasoning in medical students through the acquisition of cognitive user interface (UI) heuristics and (2) understand qualitatively how clinical data visualizations could enhance medical education. Third- and fourth-year medical students were presented patient cases through a novel electronic health record (EHR) design then asked to diagnose patients after being shown the cases either briefly and repeatedly (Group A) or twice over a longer period (Group B). Group A had higher accuracy than Group B. Findings support the possibility of inducing System-1 reasoning via UI heuristics and potential of integrating data visualizations in medical education.

Background: Nasoorbitoethmoid (NOE) fractures impact growth of the craniofacial skeleton in children, which may necessitate differentiated management from adult injuries. This study describes characteristics, management, and outcomes of NOE fractures in children seen at a single institution. Methods: A retrospective review of patients under 18 years who presented to our institution from 2006 to 2021 with facial fractures was conducted; patients with NOE fractures were included. Data collected included demographics, mechanism of injury, fracture type, management, and outcomes. Results: Fifty-eight patients met inclusion criteria; 77.6% presented with Manson–Marcowitz Type I fractures, 17.2% with Type II, and 5.2% with Type III. The most common cause of injury was motor vehicle accidents (MVAs, 39.7%) and sports (31%). Glasgow Coma Scale and injury mechanism were not predictive of injury severity in the pediatric population (P=0.353, P=0.493). Orbital fractures were the most common associated fractures (n=55, 94.8%); parietal bone fractures were more likely in Type III fractures (P=0.047). LeFort III fractures were more likely in type II fractures (P=0.011). Soft tissue and neurological injuries were the most common associated injuries regardless of NOE fracture type (81% and 58.6%, respectively). There was no significant difference in type of operative management or in the rates of adverse outcomes between types of NOE fractures. Conclusions: These findings suggest that pediatric NOE fractures, although rare, present differently from adult NOE fractures and that revisiting predictive heuristics and treatment strategies is warranted in this population.

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