Face Value: Evaluating the FISS Scoring System for Operative Intervention in Pediatric Facial Trauma

Area of Science:

• Trauma Surgery
• Pediatric Orthopedics
• Maxillofacial Surgery

Background:

• The Facial Injury Severity Scale (FISS) is used to assess maxillofacial trauma severity and predict operative necessity.
• Its utility in pediatric populations with facial fractures requires further investigation.

Purpose of the Study:

• To evaluate the association between the Facial Injury Severity Scale (FISS) and the need for operative management in pediatric facial fractures.
• To determine if FISS can reliably predict surgical intervention in children.

Main Methods:

• Retrospective cohort study of patients under 18 years with facial fractures (May 2021-February 2025).
• Collected demographics, injury details, and operative data; excluded incomplete records or mortality.
• Calculated FISS scores and compared between nonoperative and operative groups using univariate and multivariate analyses.

Main Results:

• 312 pediatric patients included; 32.7% underwent operative management.
• Operative group showed higher rates of mandibular and LeFort I fractures, but lower rates of orbital, calvarium, nasal fractures, and traumatic brain injury.
• Median FISS scores were significantly higher in the operative group (5 vs. 2, P <0.001).
• Assault mechanism, mandibular fractures, and higher FISS scores independently predicted operative intervention.

Conclusions:

• Elevated FISS scores are associated with surgical intervention in pediatric facial fractures.
• FISS can assist in risk assessment, triage, and patient counseling for pediatric facial trauma.
• Operative decisions should consider FISS scores alongside injury mechanism and fracture location.