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Emergency Radiology

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Open Access 01-02-2020 | Computed Tomography | Original Article

Predicting orbital fractures in head injury: a preliminary study of clinical findings

Authors: James R. Allison, Andrew Kearns, Robert J. Banks

Published in: Emergency Radiology | Issue 1/2020

Abstract

Purpose

Patients presenting to emergency departments (EDs) following head injury often undergo computed tomography (CT) of the head to exclude traumatic brain injury. In many cases, this does not show the maxillofacial skeleton. A proportion of these patients also sustain facial fractures, and when fractures involve the orbits, CT imaging is useful in diagnosis and management; obtaining a second scan may cause delay, incur greater cost, and increase radiation dose. The aim of this preliminary study was to examine the value of signs and symptoms of orbital fractures in predicting a fracture on CT.

Methods

The clinical records of 47 patients who underwent CT of the face following facial trauma were retrospectively examined for the presence of signs and symptoms of orbital fractures. Sensitivity, specificity, negative predictive value (NPV) and positive predictive values (PPV) were then calculated for each sign and symptom for the presence of an orbital fracture on CT. We also described a clinical decision instrument and examined the predictive values of this.

Results

Change in the position of the globe, reduced visual acuity, subconjunctival haemorrhage and change in sensation in the maxillary division of the trigeminal nerve were the most specific signs and symptoms for orbital fracture. Our clinical decision instrument had 80.0% sensitivity, 75.0% specificity, 90.3% PPV and 56.3% NPV for predicting the presence of an orbital fracture on CT in this population.

Conclusions

Our results demonstrate that signs and symptoms of orbital fractures may be useful for predicting these injuries, and a decision instrument could be used in the ED to identify patients likely to benefit from extending the radiation field to include the orbits where CT of the head is already planned. This work is however exploratory; and further prospective validation is required before a robust instrument can be recommended for clinical use.

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Title: Predicting orbital fractures in head injury: a preliminary study of clinical findings
Authors: James R. Allison
Andrew Kearns
Robert J. Banks
Publication date: 01-02-2020
Publisher: Springer International Publishing
Keywords: Computed Tomography
Computed Tomography
CT of the Head
Facial Fracture
Facial Fracture
Maxillofacial Injuries
Published in: Emergency Radiology / Issue 1/2020
Print ISSN: 1070-3004
Electronic ISSN: 1438-1435
DOI: https://doi.org/10.1007/s10140-019-01720-0

At a glance: The STEP trials

Springer Medicine

Predicting orbital fractures in head injury: a preliminary study of clinical findings

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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