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Incidence of Concussion in Patients With Isolated Mandible Fractures
Lindsay Sobin1, Robert Kopp2, Ronald Walsh2
1Department of Otolaryngology, State University of New York Upstate Medical Center, Syracuse2currently with the Department of Otolaryngology, Boston Children's Hospital, Boston, Massachusetts.
Importance:
This study examines the association between isolated mandible fractures and mild traumatic brain injury (mTBI).
Objective:
To determine the rates of mTBI in patients who have sustained isolated mandible fractures.
Design, Setting, And Participants:
A prospective study was conducted among patients who sustained isolated mandible fractures within 24 hours of presentation. Patients were administered the Military Acute Concussion Evaluation (MACE). Recorded data included demographics, time since injury, use of alcohol or illicit drugs, nonfacial pain, and mechanism of injury. All patients were evaluated in the emergency department of a level I trauma center between June 20, 2013, and June 20, 2014. In addition, discharge data from the Nationwide Inpatient Sample database was analyzed to identify current rates of patients with a diagnosis of both mandible fractures and concussions.
Main Outcomes And Measures:
Rates of concussion. Patients with a MACE score of less than 25 were considered to have mTBI.
Results:
Sixteen patients met the study criteria over a 1-year period. Fourteen patients (88%) were male, and mean age was 27.5 years. The mean time since injury was 11.25 hours (range, 3-21 hours). The mechanism of injury was assault in 12 patients (75%), sports in 2 patients (13%), all-terrain vehicle crash in 1 patient (6%), and biking in 1 patient (6%). Eight patients (50%) admitted to the use of alcohol, and none reported the use of illicit drugs. Eleven patients (69%) reported loss of consciousness. Twelve patients (75%) met criteria for concussion according to the MACE. Among these 12 patients, 7 (58%) admitted to the use of alcohol at the time of injury. There was no relationship between the rates of concussion and the use of alcohol.
Conclusions And Relevance:
Mandible fractures are often sustained after high-force impacts during altercations between men. In our study, a 75% (12 of 16) rate of concussions associated with isolated mandible fractures was identified. Patients with isolated mandible fractures may benefit from being screened for concussion and referred to a concussion clinic.
Level Of Evidence:
4.
Insights
Isolated mandible fractures are frequently associated with mild traumatic brain injury (mTBI), also known as concussion. This study found a high rate of concussion in patients with mandible fractures, suggesting the need for screening.
Area of Science:
- Trauma surgery
- Neurology
- Emergency medicine
Background:
- Isolated mandible fractures often result from high-impact incidents, particularly assaults.
- The co-occurrence of mild traumatic brain injury (mTBI) with mandible fractures is not fully understood.
- Assessing mTBI rates in this patient population is crucial for comprehensive care.
Purpose of the Study:
- To determine the incidence of mTBI in patients presenting with isolated mandible fractures.
- To investigate the association between mandible fractures and concussion in a prospective cohort.
- To evaluate the utility of the Military Acute Concussion Evaluation (MACE) in this context.
Main Methods:
- A prospective study enrolled patients with isolated mandible fractures within 24 hours of presentation.
- The Military Acute Concussion Evaluation (MACE) was administered to assess for mTBI.
- Data collected included demographics, injury mechanism, substance use, and pain.
- Nationwide Inpatient Sample data was analyzed for concurrent mandible fracture and concussion diagnoses.
Main Results:
- Of 16 patients with isolated mandible fractures, 12 (75%) met criteria for concussion via MACE.
- Assault was the most common mechanism of injury (75%).
- Alcohol use was reported by 50% of patients, but showed no correlation with concussion rates.
Conclusions:
- A high rate (75%) of concussion was observed in patients with isolated mandible fractures.
- Mandible fractures, often caused by altercations, warrant screening for associated mTBI.
- Patients with mandible fractures may benefit from targeted concussion evaluation and referral.
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