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Isolated facial fractures transferred for higher level of care

  • Emily Lenart
    Affiliations
    Trauma and Surgical Critical Care Division, Department of Surgery, The University of Tennessee Health Science Center, 910 Madison Ave, 2nd Floor, Room 220, Memphis, TN, 38163, USA
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  • Dina Filiberto
    Affiliations
    Trauma and Surgical Critical Care Division, Department of Surgery, The University of Tennessee Health Science Center, 910 Madison Ave, 2nd Floor, Room 220, Memphis, TN, 38163, USA
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  • Peter Fischer
    Affiliations
    Trauma and Surgical Critical Care Division, Department of Surgery, The University of Tennessee Health Science Center, 910 Madison Ave, 2nd Floor, Room 220, Memphis, TN, 38163, USA
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  • Isaac Howley
    Affiliations
    Trauma and Surgical Critical Care Division, Department of Surgery, The University of Tennessee Health Science Center, 910 Madison Ave, 2nd Floor, Room 220, Memphis, TN, 38163, USA
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  • Saskya Byerly
    Correspondence
    Corresponding author.
    Affiliations
    Trauma and Surgical Critical Care Division, Department of Surgery, The University of Tennessee Health Science Center, 910 Madison Ave, 2nd Floor, Room 220, Memphis, TN, 38163, USA
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Published:September 21, 2022DOI:https://doi.org/10.1016/j.amjsurg.2022.09.032

      Highlights

      • IFF are often nonoperative and require few urgent interventions.
      • IFF are often transferred to level I traumas centers in an emergent setting.
      • There is a need for IFF transfer guidelines, telehealth, and outpatient referral via a multidisciplinary collaboration.

      Abstract

      Background

      Isolated facial fractures (IFF) have been identified as overtriaged injuries in multiple single-center studies. We sought to describe IFF in a national database.

      Methods

      The 2019 Trauma Quality Improvement Program database was queried for all patients with facial fractures and Abbreviated Injury Score<1 for other body regions. Descriptive statistics were performed.

      Results

      Of 1,097,190 trauma patients, 36,077 (3.3%) had IFF. Median age was 39 [26–89], 92% had blunt mechanism, median Glasgow Coma Scale 15 [15-15], and vital signs were normal (ED systolic blood pressure 137 [125–153], ED pulse 86 [73–99]). 0.3% required unplanned intubation. 25.7% underwent operation after a median interval 26.4 [14.4–47.9] hours. IFF patients represented 4.4% of interfacility transfers and were more likely to have been transferred (34.4% vs 25%, p < 0.001). Hospital stay was 3 [2–4] days.

      Conclusions

      IFF are rarely surgical emergencies and frequently nonoperative, yet are disproportionately represented among transfers. IFFs may represent an opportunity for outpatient follow-up or telehealth consultation to decrease resource utilization.
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