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To scan or not to scan - a service improvement project for CT in facial trauma

Lookup NU author(s): James Allison

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Abstract

Introduction and Aims:Facial trauma patients often receive CTs to exclude head injury, but these rarely include the orbits or facial bones. As CT is useful in managing orbital fractures, this service improvement project aims to examine practice and streamline the process for patients with likely fractures, already receiving a CT.Materials and Methods: We retrospectively searched hospital records over 9 months for patients who received a CT head following trauma, and were reviewed by OMFS, to look at the investigations they received.We also searched a separate 10 month period to identify from patients who received a facial CT for trauma, which signs and symptoms were predictive of an orbital fracture.Results: Of almost 80,000 patients seen in the ED, 45 received a CT of the head and were reviewed by OMFS for trauma. In 79% of cases the maxillofacial region was not included in the initial CT; of these, 48% received additional imaging, with 13% having a further CT.Of all signs and symptoms present at assessment, hypoglobus and reduced acuity had greatest sensitivity for diagnosing orbital fracture; ecchymosis, subconjunctival haemorrhage, diplopia and limitation of eye movement were also predictive. A median of 2 signs were present in patients with fractures, and 0 in those without.Conclusions/Clinical Relevance: Were able to implement a policy in the ED of including the orbits and facial bones, when signs and symptoms suggested a fracture. This will reduce radiation dose to patients where an additional CT scan would otherwise have been undertaken.


Publication metadata

Author(s): Allison JR, Kearns A

Publication type: Article

Publication status: Published

Journal: British Journal of Oral and Maxillofacial Surgery

Year: 2017

Volume: 55

Issue: 10

Pages: e129-e130

Print publication date: 01/12/2017

Online publication date: 14/12/2017

Acceptance date: 14/12/2017

ISSN (print): 0266-4356

ISSN (electronic): 1532-1940

Publisher: Elsevier

URL: https://doi.org/10.1016/j.bjoms.2017.08.128

DOI: 10.1016/j.bjoms.2017.08.128


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