Christopher N Stewart1, Lily Wood1, Ruth Jo Barta2. 1. Department of Surgery, University of Minnesota, Minneapolis, MN, USA. 2. Regions Hospital, HealthPartners, Saint Paul, MN, USA.
Abstract
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.
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.
Authors: Thomas J Sitzman; Summer E Hanson; Nila H Alsheik; Lindell R Gentry; John F Doyle; Karol A Gutowski Journal: Plast Reconstr Surg Date: 2011-03 Impact factor: 4.730
Authors: I G Stiell; G H Greenberg; R D McKnight; R C Nair; I McDowell; M Reardon; J P Stewart; J Maloney Journal: JAMA Date: 1993-03-03 Impact factor: 56.272