Comprehensive Facial Injury Score and Facial Injury Severity Score as Injury Severity Indicators: A Comparative Study

Background: The Comprehensive Facial Injury Score (CFI) and Facial Injury Severity Score (FISS) are validated scoring systems used to assess the severity of maxillofacial injuries. Direct comparative evidence of their associations with multiple clinical severity indicators remains limited. This study aimed to compare CFI and FISS in assessing the severity of maxillofacial injuries, including length of hospital stay (LOS), need for surgical intervention (NSI), overall surgical time (OST), and need for interdisciplinary management (IDM). Methods: A retrospective review of 280 medical records of patients with maxillofacial injuries between January 2016 and December 2021 was conducted. Pearson and point-biserial correlation analyses were performed to assess the association between CFI and FISS scores with all four outcome variables. Results: CFI demonstrated strong positive correlations with LOS (r = 0.65, p < 0.001) and OST (r = 0.74, p < 0.001), compared to moderate correlations for FISS (r = 0.41 and r = 0.54, respectively; both p < 0.001). For NSI, CFI showed a strong correlation (r_pβ = 0.612, p < 0.001), whereas FISS showed a moderate correlation (r_pβ = 0.373, p < 0.001). For IDM, CFI demonstrated a moderate correlation (r_pβ = 0.384, p < 0.001) while FISS showed only a weak correlation (r_pβ = 0.150, p = 0.012). Both scoring systems demonstrated convergent validity, confirming they measure a related underlying construct of maxillofacial injury severity. Conclusions: CFI demonstrated stronger correlations with all four severity indicators compared to FISS, suggesting a stronger association in this study population. These findings support the potential utility of CFI in stratifying maxillofacial injury severity.