DOI

10.17077/etd.y9h1-2a48

Document Type

Dissertation

Date of Degree

Fall 2011

Degree Name

PhD (Doctor of Philosophy)

Degree In

Epidemiology

First Advisor

James C. Torner

First Committee Member

James C Torner

Second Committee Member

Corinne Peek-Asa

Third Committee Member

Elizabeth A Chrischilles

Fourth Committee Member

Marizen Ramirez

Fifth Committee Member

Kirk T Phillips

Sixth Committee Member

Sheryl M Sahr

Seventh Committee Member

Todd J Janus

Abstract

Facial fractures are commonly present in hospital patients admitted for trauma care. The establishment of clinical indicators for uncovering facial fractures has been insufficiently studied. The main objectives of this study were to determine midface facial fracture diagnostics, etiology, characteristics, indicators, related outcomes, and treatments within a trauma patient population. A clinical epidemiologic study was conducted using a retrospective observational design. Level I trauma center data was used from the years of 2007-2009. Key data sources were Iowa Methodist Trauma registry, radiographic scans and notes, electronic medical records, and billing records. A case-control and a retrospective cohort design were used to address study objectives. Analyses included bivariate comparative tests along with multivariate logistic regression modeling.

The study demonstrated that the majority of facial fractures in the patient population were diagnosed with maxillofacial computed tomography scans. Patients had a median of 2 (interquartile range: 2-4) facial fractures with the orbit bones being the most commonly fractured bones. Of patients with fracture, 48% had a direct or indirect health outcome related to their fracture and 51% of patients had their fracture left to self-resolve with minimal self-care. Statistically significant indicators of facial fracture included the presence of periorbital contusion, open wound of the forehead, epistaxis, blood in ethmoid sinus, and blood in maxillary sinus, while motor vehicle collision appeared to have a disproportionately low relationship with fracture. Based on these risk factors, three potential risk groups for facial fracture were proposed, stratifying study patients into subpopulations per their estimated risk level. Study results will help clinicians better understand facial fracture. The revealed indicators and risk levels for facial fracture may serve to help determine when fractures may be present in similar trauma patient populations. Further research should be conducted to validate the internal validity as well as the generalizability of study results in other trauma centers and patients.

Keywords

Diagnostics, Facial Fracture, Indicators, Prevention, Trauma

Pages

2, xiii, 150 pages

Bibliography

Includes bibliographical references (pages 146-150).

Copyright

Copyright 2011 Hayden Lee Smith

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