Computed tomography of the head as a screening examination for facial fractures

We hypothesized that head computed tomography (CT) is an accurate screening tool for detecting nonnasal midfacial fractures in trauma patients. We retrospectively reviewed charts and official readings for all patients who underwent both head and facial CT scans for trauma at our trauma center between August 2002 and April 2003. The ability of head CT to diagnose nonnasal bone midfacial fractures was compared with that of facial CT using sensitivity, specificity, accuracy, as well as positive and negative predictive values. Agreement was measured with kappa statistics. Ninety-five percent confidence intervals (CIs) were used to assess precision. Ninety-one patient records with head and facial CT scan reports were reviewed. Of the patients, 50 (55%) had nonnasal bone midfacial fractures. The sensitivity and specificity of head CT were 90% (95% CI = 79%-96%) and 95% (95% CI = 84%-99%), respectively; the positive and negative predictive values were 96% (95% CI = 86%-99%) and 89% (95% CI = 76%-95%), respectively. The rate of accuracy was 92%. The agreement was excellent (kappa = 0.85, 95% CI = 0.74-0.96). Head CT was sensitive and specific for identifying nonnasal bone midfacial fractures. An initial head CT alone may limit the need for a Waters view radiography or screening facial CT in detecting injuries.