External Validation of University of Wisconsin's Clinical Criteria for Obtaining Maxillofacial Computed Tomography in Trauma

Harrington, Amanda W.; Pei, Kevin Y.; Assi, Roland; Davis, Kimberly A.

doi:10.1097/scs.0000000000004240

Cited by 12 publications

(33 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

Section: Discussionmentioning

confidence: 99%

“…An internal validation by Sitzman et al was consistent with the original study; however, an external validation by Harrington et al failed to do so on account of low sensitivity and NPV. 6,7 Our study has the largest sample size to date evaluating the use of specific clinical exam findings to reliably predict whether a facial fracture is present. Our demographic is similar to Sitzman's group regarding age, male predominance, and mechanism of injury.…”

Section: Discussionmentioning

confidence: 99%

“…There have now been 4 studies, including this one, to determine whether the "Wisconsin criteria" are a valid decision tool in determining when to obtain facial CT scan [5][6][7] (Table 5). We were able to validate this tool as a sensitive predictor of the absence of fracture and support its use as a decision-making method for obtaining special midface CT scan.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…6 Unfortunately, an attempt of external validation by Harrington et al showed 81% sensitivity and 60% negative predictive value (NPV), raising concerns for the broad applicability of this method. 7 Dedicated imaging of the facial structures is a powerful tool in the diagnosis and ultimate management of injuries. However, this should be used in the most prudent manner to avoid excess radiation exposure for the patient and increased cost of care.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Validation of the “Wisconsin Criteria” for Obtaining Dedicated Facial Imaging and Its Financial Impact at a Level 1 Trauma Center

Stewart

Wood

Barta

2020

Craniomaxillofacial Trauma & Reconstruction

View full text Add to dashboard Cite

Introduction: According to national trauma databases, 25% of all people injured have some type of facial injury. The gold standard for diagnosing bony trauma of the facial skeleton has been computed tomography (CT) scan. In 2011, the “Wisconsin criteria” were established and subsequently validated as a method to predict which patients truly have a facial fracture and warrant further imaging. The purpose of this study is to externally validate these criteria and determine the economic impact they might have on avoiding unnecessary CT scans. Methods: This was a retrospective chart review. We collected 1000 patients who had undergone facial CT related to trauma and retrospectively applied the “Wisconsin criteria” based on physical exam documentation. Results: Of the 1000 facial CT scans obtained, we identified 408 fractures, 12% of which required operative intervention. The “Wisconsin criteria” applied to our patient population had a sensitivity of 90% and a negative predictive value of 93%. Using these criteria resulted in a missed fracture rate of 2.8%. Finally, had these criteria been used to determine when a facial CT scan was indicated, our institution could be saving over US$300 000 annually. Conclusion: The “Wisconsin criteria” are a reliable method to screen for facial fracture in trauma patients. Using a validated instrument tool to guide decision-making, we can avoid obtaining low-value imaging studies. This can have a large economic impact while maintaining safety and reliability in accurate diagnosis.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Validation of the “Wisconsin Criteria” for Obtaining Dedicated Facial Imaging and Its Financial Impact at a Level 1 Trauma Center

Stewart

Wood

Barta

2020

Craniomaxillofacial Trauma & Reconstruction

View full text Add to dashboard Cite

show abstract

A clinical decision aid to discern patients without and with midfacial and mandibular fractures that require treatment (the REDUCTION-II study): a prospective multicentre cohort study

Rozema

Moumni

Vries

et al. 2022

Eur J Trauma Emerg Surg

View full text Add to dashboard Cite

Purpose To assess the diagnostic accuracy of physical examination findings and to construct clinical decision aids to discern emergency department patients without and with midfacial and mandibular fractures that require treatment. Methods A prospective multicentre cohort study was conducted in four hospitals in the Netherlands. Consecutive maxillofacial trauma patients were included whereupon each patient underwent a standardized physical examination consisting of 15 and 14 findings for midfacial and mandibular trauma, respectively. The primary outcome was the decision whether to treat during the emergency department stay or within 24 h of admission. The diagnostic accuracy was calculated for the individual physical examination findings and ensuing clinical decision aids with the focus being on detecting midfacial and mandibular fractures that require active treatment. Results A total of 766 midfacial trauma patients were identified of whom 339 (44.3%) had midfacial fractures. Of those, 74 (21.8%) required active treatment. A total of 280 mandibular trauma patients were identified of whom 66 (23.6%) had mandibular fractures. Of those, 37 (56.0%) required active treatment. The decision aid for midfacial trauma consisting of facial depression, epistaxis, ocular movement limitation, palpable step-off, objective malocclusion and tooth mobility or avulsion had a sensitivity of 97.3 (90.7–99.3), a specificity of 38.6 (35.0–42.3), and a negative predictive value of 99.3 (97.3–99.8). The decision aid for mandibular trauma consisting of mouth opening limitation, jaw movement pain, objective malocclusion and tooth mobility or avulsion resulted in a sensitivity of 100.0 (90.6–100.0), a specificity of 39.1 (33.2–45.4), and a negative predictive value of 100.0 (96.1–100.0). Conclusion The clinical decision aids successfully identified midfacial and mandibular trauma patients requiring active fracture treatment and so may be useful in preventing unnecessary radiological procedures in the future. Trial Registration The study was registered at ClinicalTrials.gov with the identifier NCT03314480.

show abstract

A clinical decision aid for patients with suspected midfacial and mandibular fractures (the REDUCTION-I study): a prospective multicentre cohort study

Rozema

Moumni

Vries

et al. 2022

Eur J Trauma Emerg Surg

View full text Add to dashboard Cite

Purpose To assess physical examination findings related to maxillofacial trauma to identify patients at risk of midfacial and mandibular fractures and then to construct a clinical decision aid to rule out the presence of midfacial and mandibular fractures in emergency department patients. Methods We performed a prospective multicentre cohort study in four hospitals in the Netherlands, including consecutive patients with maxillofacial trauma. Each patient received a standardized physical examination consisting of 15 and 14 findings for midfacial and mandibular traumas, respectively. Consequently, clinical decision aids were constructed with the focus being on ruling out the presence of midfacial and mandibular fractures, and diagnostic accuracy was calculated. Results A total of 993 consecutive patients were identified of whom 766 and 280 patients were suspected of midfacial and mandibular fractures, respectively. Midfacial fractures were diagnosed in 339 patients (44.3%), whereas mandibular fractures were observed in 66 patients (23.6%). The decision aid for midfacial trauma consisting of peri-orbital hematoma, epistaxis, ocular movement limitation, infra-orbital nerve paresthesia, palpable step-off and tooth mobility or avulsion, produced a sensitivity of 89.7 (86.0–92.5), a specificity of 42.6 (38.0–47.4), and a negative predictive value of 83.9% (78.4–88.2). The decision aid for mandibular trauma consisting of the angular compression test, axial chin pressure test, objective malocclusion, tooth mobility or avulsion and the tongue blade bite test resulted in a sensitivity of 98.5 (91.9–99.7), a specificity of 34.6 (28.5–41.2), and a negative predictive value of 98.7% (92.8–99.8). Conclusion The constructed clinical decision aids for maxillofacial trauma may aid in stratifying patients suspected for midfacial and mandibular fractures to reduce unnecessary diagnostic imaging. Clinical Trial Registration The study was registered at ClinicalTrials.gov with the identifier NCT03314480.

show abstract

External Validation of University of Wisconsin's Clinical Criteria for Obtaining Maxillofacial Computed Tomography in Trauma

Cited by 12 publications

References 12 publications

Validation of the “Wisconsin Criteria” for Obtaining Dedicated Facial Imaging and Its Financial Impact at a Level 1 Trauma Center

Validation of the “Wisconsin Criteria” for Obtaining Dedicated Facial Imaging and Its Financial Impact at a Level 1 Trauma Center

A clinical decision aid to discern patients without and with midfacial and mandibular fractures that require treatment (the REDUCTION-II study): a prospective multicentre cohort study

A clinical decision aid for patients with suspected midfacial and mandibular fractures (the REDUCTION-I study): a prospective multicentre cohort study

Contact Info

Product

Resources

About