Facial imaging in an urban emergency department

To describe the facial imaging practice pattern in our an emergency department and to assess the implications of this practice, a retrospective review was conducted of patients with blunt facial trauma requiring facial imaging over a 2-month period. Patients were compared based on their initial imaging study, either facial x-rays (primary FXR) or spiral computed tomography (primary FSCT). Of 211 patients imaged, 148 (70%) received primary FXR and 63 (30%) primary FSCT. A greater proportion of primary FSCT patients had at least one fracture detected (57% v. 26%; odds ratio 3.9, confidence interval 2.0-7.5). Of patients with a fracture on FXR, 29% underwent secondary FSCT. The average facial imaging charges per case detected (patient with a fracture) were $978 for primary FXR and $2,048 for primary FSCT. Physicians made avid use of FSCT. Additional studies are needed to determine the appropriateness of this practice and to improve clinical selection of patients requiring FSCT.