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What Factors Influence Hospital Admission for Mandible Fractures in Emergency Departments Across the United States?
Brendan W Wu1, Mia M Joseph1, Vasiliki Karlis2
1Resident, Department of Oral and Maxillofacial Surgery, New York University Langone Health and Bellevue Hospital Center, New York, NY.
Background:
Facial trauma surgeons consulted by emergency departments (EDs) for mandible fractures must decide whether hospital admission is warranted. While admission may allow for closer monitoring and expedited surgery, many patients present with clinically stable injuries for which outpatient management is feasible.
Purpose:
This study aims to identify biological, situational, and socioeconomic predictors of admission for mandible fractures presenting to EDs across the United States.
Study Design, Setting, And Sample:
This was a retrospective cohort study of the 2022 Nationwide Emergency Department Sample. Subjects diagnosed with mandible fractures (International Classification of Diseases, 10th Revision, Clinical Modification S02.6-) were included. Subjects who died in the ED or left against medical advice were excluded.
Predictor Variables:
The predictor variables consisted of a heterogeneous set of demographic, hospital-related, and injury-related risk factors.
Main Outcome Variables:
The outcome variables were admission status and ED charges.
Covariates:
None.
Analyses:
Descriptive statistics were calculated for all variables. Bivariate analyses were performed using t tests and χ2 tests. A multivariable logistic model was used to identify independent predictors of admission. A P value <.05 was considered statistically significant.
Results:
The sample was composed of 12,160 subjects with a mean age of 39 years (SD = 19), and 9,117 (75%) were male. A total of 5,236 (43%) subjects were admitted. Mandibular symphysis fractures had the highest likelihood of admission (P < .001), whereas body fractures had the lowest likelihood (P < .001). In a multivariable logistic model, male sex (OR: 1.23; 95% CI: 1.11 to 1.36), number of mandible fractures (OR: 2.81; 95% CI: 2.61 to 3.02), concomitant midface fractures (OR: 3.25; 95% CI: 2.89 to 3.65), and firearm injuries (OR: 16.16; 95% CI: 11.50 to 22.71) were associated with admission, whereas uninsured patients were less likely to be admitted (OR: 0.84; 95% CI: 0.75 to 0.94). Admissions were more costly than discharges ($15,511 vs $4,899, P < .001).
Conclusion And Relevance:
Disposition decisions for mandible fractures are influenced by not only injury severity (eg, multiple mandible fractures, concomitant facial fractures) but also patient characteristics and socioeconomic factors. These findings support the development of standardized admission criteria to improve equity and resource utilization.
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