@article{ref1,
title="Incidence of intracranial injury in orbital wall fracture patients not classified as traumatic brain injury",
journal="Injury",
year="2018",
author="Lee, Hyung-Joo and Kim, Youn-Jung and Seo, Dong-Woo and Sohn, Chang Hwan and Ryoo, Seung Mok and Ahn, Shin and Lee, Yoon-Seon and Kim, Won Young and Lim, Kyoung Soo",
volume="49",
number="5",
pages="963-968",
abstract="OBJECTIVE: The detection of intracranial injury in patients with facial injury rather than traumatic brain injury (TBI) remains a challenge for emergency physicians. This study aimed to evaluate the incidence and risk factors of intracranial injury in patients with orbital wall fracture (OWF), who were classified with a chief complaint of facial injury rather than TBI. <br><br>METHODS: This retrospective case-control study enrolled adult OWF patients (age ≥18 years) who presented at the hospital between January 2004 and March 2016. Patients with definite TBI were excluded because non-contrast head computed tomography (CT) is recommended for such patients. <br><br>RESULTS: A total of 1220 patients with OWF were finally enrolled. CT of the head was performed on 677 patients, and the incidence of concomitant intracranial injury was found to be 9% (62/677). Patients with definite TBI were excluded. Symptoms raising a suspicion of TBI, such as loss of consciousness, alcohol intoxication, or vomiting, were present in 347 of the patients, with 44 of these patients (13%) showing a concomitant intracranial injury. Of the 330 patients without such symptoms, 18 (6%) demonstrated a concomitant intracranial injury. In OWF patients, superior wall fracture (odds ratio [OR], 4.15; 95% confidence interval [CI], 2.06-8.34; P < 0.001), associated frontal bone fracture (OR, 4.38; 95% CI, 2.08-9.23; P < 0.001), and older age (decades) (OR, 1.03; 95% CI, 1.01-1.04; P = 0.002) were independent risk factors for concomitant intracranial injury. <br><br>CONCLUSIONS: Emergency physicians should maintain a high degree of suspicion of TBI, even when their primary concern is facial trauma with OWF. Head CT is recommended for OWF patients with a superior OWF, frontal bone fracture, or increased age.<br><br>Copyright © 2018 Elsevier Ltd. All rights reserved.<p /> <p>Language: en</p>",
language="en",
issn="0020-1383",
doi="10.1016/j.injury.2018.02.025",
url="http://dx.doi.org/10.1016/j.injury.2018.02.025"
}