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An assessment tool for orbital trauma - should the orbits be included in head CT?

Lookup NU author(s): James Allison, Robert Banks

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Abstract

Introduction and Aims: Many patients undergo CT of the head to exclude brain injury, which frequently does not include the orbits. Patients with maxillofacial injuries may go on to receive additional imaging, incurring additional cost, time and radiation exposure. We aim to examine the signs and symptoms of orbital fractures to develop a tool to assess the benefit of including the orbits inpatients already undergoing CT head.Materials and Methods: We retrospectively searched the records of patients presenting to a district general hospital in the north of England, who underwent CT of the orbits for trauma between January 2016 and June 2017. Records from initial presentation were used to identify the presence of signs and symptoms of an orbital fracture. The CT report was used to identify the presence of a fracture. We used this to calculate the value of the signs and symptoms for predicting a fracture of the orbit.Results: 47 patients were included, 74.5% (n = 35) had a fracture of the orbit. We found that our tool (any two of: periorbital bruise, diplopia, limitation of movement. OR, one of: subconjunctival haemorrhage, V2 numbness, change in globe position or reduced acuity) had 80.0% sensitivity and 75.0% specificity for predicting a fracture.Conclusions/Clinical Relevance: This assessment tool could be used by emergency department clinicians to quickly assess the likelihood of a fracture, and the benefit of including the orbits in patients already undergoing CT of the head.


Publication metadata

Author(s): Allison JR, Kearns A, Banks R

Publication type: Article

Publication status: Published

Journal: British Journal of Oral and Maxillofacial Surgery

Year: 2018

Volume: 56

Issue: 10

Pages: e66-e66

Print publication date: 01/12/2018

Online publication date: 18/12/2018

Acceptance date: 20/07/2018

Date deposited: 20/12/2018

ISSN (print): 0266-4356

ISSN (electronic): 1532-1940

Publisher: Churchill Livingstone

URL: https://doi.org/10.1016/j.bjoms.2018.10.188

DOI: 10.1016/j.bjoms.2018.10.188


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