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Original Investigation |

Patterns of Facial Fractures and Protective Device Use in Motor Vehicle Collisions From 2007 to 2012 ONLINE FIRST

David A. Hyman, MD1; Sandeep Saha, MS2; Harry S. Nayar, MD3; John F. Doyle, DDS3; Suresh K. Agarwal, MD4; Scott R. Chaiet, MD, MBA1
[+] Author Affiliations
1Division of Otolaryngology–Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison
2Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison
3Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison
4Division of General Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison
JAMA Facial Plast Surg. Published online July 21, 2016. doi:10.1001/jamafacial.2016.0733
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Importance  Facial fractures after motor vehicle collisions are a significant source of facial trauma in patients seen at trauma centers. With recent changes in use of seat belts and advances in airbag technology, new patterns in the incidence of facial fractures after motor vehicle collisions have yet to be quantified.

Objectives  To evaluate the incidence of facial fractures and assess the influence of protective device use in motor vehicle collisions in patients treated at trauma centers in the United States.

Design, Setting, and Participants  Using a data set from the National Trauma Data Bank, we retrospectively assessed facial fractures in motor vehicle collisions occurring from 2007 through 2012, reported by level I, II, III, and IV trauma centers. Data analysis was performed from March 13 to September 22, 2015.

Main Outcomes and Measures  We characterized the data set by subsite of facial injury using International Classification of Diseases, Ninth Revision codes including mandible, midface, and nasal fractures. We assessed the influence of variables such as age, sex, race/ethnicity, crash occupant (driver or passenger), use of protective device, and presence or suspicion of alcohol use.

Results  A total of 518 106 patients required assessment at a trauma center after a motor vehicle collision, with 56 422 (10.9%) experiencing at least 1 facial fracture. Nasal fracture was the most common facial fracture (5.6%), followed by midface (3.8%), other (3.2%), orbital (2.6%), mandible (2.2%), and panfacial fractures (0.8%). Of the subset sustaining at least 1 facial fracture, 5.8% had airbag protection only, 26.9% used a seat belt only, and 9.3% used both protective devices, while 57.6% used no protective device. Compared with no protective device, the use of an airbag alone significantly reduced the likelihood of facial fracture after a motor vehicle collision (odds ratio, 0.82; 95% CI, 0.79-0.86); use of a seat belt alone had a greater effect (odds ratio, 0.57; 95% CI, 0.56-0.58) and use of both devices provided the greatest odds reduction (odds ratio, 0.47; 95% CI, 0.45-0.48). Younger age, male sex, and alcohol use significantly increased the likelihood of facial fracture.

Conclusions and Relevance  For patients who presented to US trauma centers after motor vehicle collisions between 2007 and 2012, airbags, seat belts, and the combination of the 2 devices incrementally reduced the likelihood of facial fractures.

Level of Evidence  3.

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Figure.
Facial Fracture Incidence and Protective Device Use Reported in the National Trauma Data Bank, 2007-2012

The trend demonstrates increased use of protective devices during 2007-2012 with stable to slightly decreased incidence of facial fractures. These data do not necessarily reflect generalizable results and may be owing to sampling or reporting differences in each reporting year.

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