Traumatic brain injury in patients with facial fracture – A challenge for the clinician? - 07/03/25

Doi : 10.1016/j.jormas.2025.102302

L Kokko ^a,^{^{1
Lemminkäisenkatu 2, 20520 Turku, Finland},}^⁎ , T Puolakkainen ^b,^c,^{^{2
Haartmaninkatu 1, PL 41, 00014 Helsingin Yliopisto, Helsinki, Finland},}^{^{3
Haartmaninkatu 4,PL 320, 00029, HUS, Helsinki, Finland}}, H Thorén ^a,^{^{1
Lemminkäisenkatu 2, 20520 Turku, Finland}}, A Piippo-Karjalainen ^d,^{^{4
Haartmaninkatu 4, PL 320, 00029, HUS, Helsinki, Finland}}, AL Suominen ^e,^f,^{^{5
Yliopistonrinne 3,Canthia building, staircase B, Kuopio, Finland},}^{^{6
Puijonlaaksontie 2, 70200 Kuopio, Finland}}, J Snäll ^b,^c,^{^{2
Haartmaninkatu 1, PL 41, 00014 Helsingin Yliopisto, Helsinki, Finland},}^{^{3
Haartmaninkatu 4,PL 320, 00029, HUS, Helsinki, Finland}}
^a Department of Oral and Maxillofacial Surgery, University of Turku, Turku, Finland
^b Department of Oral and Maxillofacial Diseases, University of Helsinki
^c Helsinki University Hospital, Helsinki, Finland
^d Department of Neurosurgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
^e Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
^f Oral and Maxillofacial Diseases Teaching Unit, Kuopio University Hospital, Kuopio, Finland

^⁎Corresponding author at: Address: Lemminkäisenkatu 2, 20520 Turku, Finland.Lemminkäisenkatu 2Turku20520Finland

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Friday 07 March 2025

Résumé

Objective

This study aimed to evaluate the occurrence and clinical predictors for missed traumatic brain injury (TBI) diagnosis at primary evaluation in facial fracture patients. The specific aim was to compare the risk between adults and elderly patients.

Materials and methods

A retrospective study was performed, and data were collected from medical records. All adult facial fracture patients with associated TBI and a primary Glasgow Coma Scale score of 13 or more diagnosed and treated between 2013 and 2018 were included. The elderly group comprised patients aged at least 65 years at the time of injury.

Results

Altogether 253 patients with facial fracture and associated TBI were assessed. In 7.1 % of the cases, the diagnosis of TBI was missed in primary evaluation and thus delayed. When the different age groups were compared, the elderly had a 2.8-fold risk of missed TBI diagnosis (95 % CI 1.1–7.2, p=.0349).

Conclusions

Facial fracture patients are at significant risk of the diagnosis of associated TBI being missed at primary evaluation. Especially elderly patients with other than high-energy trauma mechanism, such as falling on ground level, are at risk of missed TBI diagnosis. Thus, patients with facial fracture should be carefully evaluated to exclude potential TBI. Assessment should occur in trauma centres where multiprofessional evaluation of these patients is routine.

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Keywords : Facial trauma, Facial fracture, Traumatic brain injury, Associated injury, Delay in diagnosis