Initial Imaging for Adults With Maxillofacial Trauma in a National Claims Database

Area of Science:

• Medical Imaging
• Health Services Research
• Trauma Surgery

Background:

• Plain radiography has limited diagnostic value in maxillofacial trauma and is considered low-value care.
• Guidelines recommend computed tomography (CT) for indicated imaging, yet plain radiography is commonly used.

Purpose of the Study:

• To examine national trends, associated factors, and consequences of low-value plain radiography in initial maxillofacial trauma imaging.
• To analyze the utilization of plain radiography versus CT in adults with facial trauma.

Main Methods:

• Retrospective cohort study using administrative claims data (2013-2022).
• Included adults with facial trauma diagnosis receiving plain radiography or CT within 7 days.
• Excluded mandibular trauma, prior facial imaging; analyzed patient/practitioner factors and downstream outcomes.

Main Results:

• 25.6% of 281,421 patients received low-value plain radiography; use declined from 32.9% to 18.0% over the study period.
• Factors associated with low-value imaging included female sex, urgent care settings, and family medicine practitioners.
• Surgical specialists and emergency departments were associated with lower odds of low-value imaging; 5.5% of radiograph recipients had follow-up CT.

Conclusions:

• Low-value plain radiography remains prevalent in initial maxillofacial trauma imaging despite guidelines favoring CT.
• Targeted interventions can reduce low-value imaging, potentially improving diagnostic accuracy and reducing costs.
• Reducing low-value imaging aligns with advancing value-based care principles.