Is a black eye a useful sign of facial fractures in patients with minor head injuries? A retrospective analysis in a level I trauma centre over 10 years

Büttner, Michael; Schlittler, Fabian Lukas; Michel, Chantal; Exadaktylos, Aristomenis; Iizuka, Tateyuki (2014). Is a black eye a useful sign of facial fractures in patients with minor head injuries? A retrospective analysis in a level I trauma centre over 10 years. British journal of oral & maxillofacial surgery, 52(6), pp. 518-522. Elsevier 10.1016/j.bjoms.2014.03.018

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Orbital blunt trauma is common, and the diagnosis of a fracture should be made by computed tomographic (CT) scan. However, this will expose patients to ionising radiation. Our objective was to identify clinical predictors of orbital fracture, in particular the presence of a black eye, to minimise unnecessary exposure to radiation. A 10-year retrospective study was made of the medical records of all patients with minor head trauma who presented with one or two black eyes to our emergency department between May 2000 and April 2010. Each of the patients had a CT scan, was over 16 years old, and had a Glasgow Coma Score (GCS) of 13-15. The primary outcome was whether the black eye was a valuable predictor of a fracture. Accompanying clinical signs were considered as a secondary outcome. A total of 1676 patients (mean (SD) age 51 (22) years) and minor head trauma with either one or two black eyes were included. In 1144 the CT scan showed a fracture of the maxillofacial skeleton, which gave an incidence of 68.3% in whom a black eye was the obvious symptom. Specificity for facial fractures was particularly high for other clinical signs, such as diminished skin sensation (specificity 96.4%), diplopia or occulomotility disorders (89.3%), fracture steps (99.8%), epistaxis (95.5%), subconjunctival haemorrhage (90.4%), and emphysema (99.6%). Sensitivity for the same signs ranged from 10.8% to 22.2%. The most striking fact was that 68.3% of all patients with a black eye had an underlying fracture. We therefore conclude that a CT scan should be recommended for every patient with minor head injury who presents with a black eye.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > University Emergency Center
04 Faculty of Medicine > Department of Orthopaedic, Plastic and Hand Surgery (DOPH) > Clinic of Orthopaedic Surgery
04 Faculty of Medicine > University Psychiatric Services > University Hospital of Child and Adolescent Psychiatry and Psychotherapy
04 Faculty of Medicine > Department of Head Organs and Neurology (DKNS) > Clinic of Craniomaxillofacial Surgery
04 Faculty of Medicine > University Psychiatric Services > University Hospital of Child and Adolescent Psychiatry and Psychotherapy > Research Division

UniBE Contributor:

Büttner, Michael; Schlittler, Fabian Lukas; Michel, Chantal; Exadaktylos, Aristomenis and Iizuka, Tateyuki

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0266-4356

Publisher:

Elsevier

Language:

English

Submitter:

Nicole Jansen

Date Deposited:

18 Aug 2014 08:41

Last Modified:

11 Nov 2015 11:39

Publisher DOI:

10.1016/j.bjoms.2014.03.018

PubMed ID:

24793410

Uncontrolled Keywords:

Black eye, Clinical predictors, Computed tomography, Orbital fractures, Retrospective study

BORIS DOI:

10.7892/boris.52415

URI:

https://boris.unibe.ch/id/eprint/52415

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