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Published on: August 16, 2019
What Are the Risk Factors for Head Injury and Traumatic Brain Injury Subtypes in Patients With Maxillofacial
Miki Yamada1, Shunsuke Hino2, Makoto Murase3
1Instructor, Department of Oral and Maxillofacial Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
Background:
Traumatic brain injury (TBI) can occur in patients with maxillofacial fractures, and early identification of patients at risk is essential for clinical management. Understanding of the relationship between fracture patterns and TBI, including its subtypes, may improve risk stratification and guide diagnostic evaluation.
Purpose:
The purpose of this study was to investigate risk factors associated with head injury and to evaluate the association between maxillofacial fracture patterns and TBI subtypes.
Study Design, Setting, And Sample:
This retrospective cohort study included patients aged ≥18 years, with maxillofacial fractures treated at Saitama Medical Center, Saitama Medical University, in Japan. The exclusion criteria were isolated dentoalveolar injuries and incomplete clinical or radiographic data.
Predictor Variables:
Predictor variables included background characteristics, mechanism of injury, and fracture sites.
Main Outcome Variables:
The primary outcome variable was the presence of head injury (yes vs no). Secondary outcome variables were focal and diffuse TBI.
Covariates:
Not applicable.
Analyses:
Bivariate analyses were performed to assess associations between predictor variables and outcomes. Multivariable logistic regression models were constructed to identify independent risk factors. Clinically relevant variables were included in the multivariable models regardless of significance. Statistical significance was defined as P < .05.
Results:
The sample comprised 712 subjects with a median age of 52.0 years; 489 (68.7%) were male, and 202 (28.4%) sustained head injuries, including 113 (15.9%) with focal TBI and 127 (17.8%) with diffuse TBI. Increasing age was statistically significantly associated with head injury (adjusted odds ratio (OR), 1.01; P = .02). Traffic accidents (adjusted OR, 5.70; P < .001) and falls from height (adjusted OR, 5.66; P = .001) were statistically significantly associated with diffuse TBI. Midface fractures were associated with higher odds of head injury, whereas mandibular condylar fractures were associated with lower odds of head injury (adjusted OR, 0.43; P = .004).
Conclusions And Relevance:
Specific mechanisms of injury and maxillofacial fracture patterns are associated with odds of head injury and TBI subtypes. Recognition of these factors may facilitate early identification of patients at risk for intracranial injury and improve clinical decision-making.
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