Lessons Learned From Ventilated and Proned Patients With COVID-19: A Multisite Retrospective Study to Identify Predictive Factors for Facial Pressure Injuries.

BACKGROUND: Many patients critically ill with COVID-19 develop acute respiratory distress syndrome (ARDS) necessitating mechanical ventilation and proning. Although proning is lifesaving, it has been linked to the occurrence of facial pressure injuries (PIs). OBJECTIVES: To evaluate the incidence and use of prevention strategies and identify predictors of facial PIs in patients who received ventilator and proning treatments in COVID-designated intensive care units at 2 large quaternary medical centers in the Midwest. METHOD: This was a retrospective cohort study using data extracted from an electronic health record between October 2020 and February 2022. Demographics, clinical and care variables, and PI outcomes were analyzed to identify predictors of PI using logistic and Cox regression. RESULTS: The cohort (N = 150) included patients from 2 units, unit a (n = 97) and unit b (n = 53) with a mean age of 60 years, with 68% identifying as male. Patients were vented for an average of 18 (SD, 16.2) days and proned for an average of 3 (SD, 2.5) days. Many (71%) died. Over half (56%) developed facial PI with a proning-exposure-adjusted incidence rate of 18.5%. Patients with PI were significantly different in several factors. Logistic regression showed predictors of PIs were duration of mechanical ventilation (in days; P = .02) and head turned (P = .01). Cox regression also identified head turn as predictive (P < .01), with Black/African American race as protective (P = .03). DISCUSSION: Critically ill patients with COVID-19 receiving ventilator and proning therapy developed facial PIs despite the use of recommended prevention practices. Further research on effective PI prevention strategies is needed.

Time to wound closure in facial soft tissue injuries following road traffic accidents.

The 6-hour (6-h) time to wound closure was a controversial issue as studies have shown that time was not a substantial factor. Wounds in the face are often considered to have a lower infection risk. Despite this, the cause of injury was not extensively discussed in relation to this context. The primary objective was to investigate the association between the 6-h time to wound closure and wound complications following emergency management of facial soft tissue injuries (STIs). Additionally, the secondary objective was to explore other factors contributing to wound complications. A retrospective record review was conducted in our hospital in Kuala Lumpur, Malaysia, from 1 January 2017 to 31 December 2021. Medical records of patients with facial STIs due to road traffic accidents were included. Simple random sampling was used to select records meeting inclusion criteria. Data on demographic, injury, and treatment characteristics were collected using a standardized proforma. Descriptive, univariate and multivariate analyses were performed, including chi-square tests and binary logistic regression. A total of 295 patient records were included, with most patients being males (77.3%) and of Malay ethnicity (54.9%). The median age was 31.0 years. Majority of patients were treated within 6 h of injury (93.9%). Complications were documented in 6.1% of cases, including wound dehiscence and infection. Multivariate analysis revealed a significant association between 6-h time to closure and wound complications (OR: 7.53, 95% CI: 1.90-29.81, p = 0.004). Grade of surgeon on duty (OR: 4.61, 95% CI: 1.25-16.95, p = 0.02) and diabetes mellitus (OR: 6.12, 95% CI: 1.23-30.38, p = 0.03) were also shown to have a statistically significant association with wound complications. A 6-h time to wound closure, grade of surgeon on duty and diabetes mellitus were three major factors involved in facial wound complications following road traffic accidents.

Surgical site infection and patient-reported outcomes in surgically treated soft tissue facial injury: A meta-analysis.

BACKGROUND: Soft tissue facial injuries (STFI) constitute a huge portion of craniofacial trauma, but the risk of surgical site infection (SSI) and patient-reported outcomes (PROs) following surgical management of STFI are unknown. METHODS: A PRISMA-compliant search was conducted from January 1990 until March 2023, and meta-analysis was performed using R. Pooled effects of the outcomes were estimated using the DerSimonian and Laird random-effects model or generalised linear mixed model, when feasible. RESULT: Among the 8897 screened studies, 38 were included. Twelve studies reported PROMs (n = 985), whereas 28 studies reported SSI rates (n = 10,996) following operative treatment for STFI. The pooled SSI rate (n = 28) was 3.30 % (95 % CI 1.89 %-5.71 %). Surgical and non-surgical closure did not differ significantly in SSI rate. PROs focused on scar outcomes, cosmetic outcomes, quality of life and psychological impact. Subgroup analysis showed lower SSI risk in operative repair for general facial trauma compared to primary repair, and in general facial trauma compared to other aetiologies. The pooled patient scar assessment scale, score at 6-12 months post-intervention (5 studies, n = 217) was 16.16 (95 % CI 15.34-16.97). Limited evidence is available on the effect and superiority of surgical treatment in cosmetic outcomes, quality of life and psychological impact. CONCLUSION: Our findings emphasise the limited and unreliable evidence available on PROs following operative treatment for STFI. Future studies employing robust methodologies are needed to investigate optimal approaches for managing STFI.

A two-year retrospective cohort study investigating the occurrence and short-term outcomes of dog-bite injures in regional Western Australia.

BACKGROUND: Dog bite injuries are a preventable yet common cause of animal related hospitalisation. Dog bites in metropolitan areas have been well characterised however there is limited information regarding dog bites in regional areas. This study sought to describe the demographics, clinical presentation and short-term outcomes of patients presenting with dog bite related injuries to Broome Regional Hospital (BRH). METHODS: A retrospective cohort study examined all dog bite related injuries presenting to BRH Emergency Department (ED) between July 1st 2021 - June 30th 2023, with the terms "dog" AND "bitten OR bite" in ED triage note. Chart review was performed to extract demographics, clinical presentation and short-term outcomes of dog bite related injuries. RESULTS: After exclusions, 207 patients were identified during the 2-year study period; approximately four dog-bites per week. Median age was 32 (IQR: 32, range 1-97 years old) with 46 % of patients being female. Residents of the Kimberley represented 78 % of presentations for dog bites. Dogs that belonged to or were known to patients were involved in 74 % of cases. The lower limb below the knee (42 %) was most commonly bitten, followed by the distal upper limb (30.5 %) and then face (13 %). Most patients presented on the same-day (67 %), were treated with antibiotics (79 %) and 83 % were discharged on the day of presentation. There were 43 (23 %) patients who required repair in the ED or operating theatre. Thirty-three patients were admitted to BRH. Seven patients required transfer for subspecialty tertiary level care. CONCLUSION: Dog-bite trauma is common and consumes significant health resources associated with ED presentations, hospital admissions, theatre usage and transfer in severe cases. A multifaceted approach encompassing education, engineering, and enforcement is required to prevent dog bites.

Profile of Facial Trauma Victims of Motorcycle Accidents: A Prospective Study.

OBJECTIVE: To outline the profile of patients with facial trauma, victims of motorcycle accidents, treated at the Hospital da Restauração, Recife/PE, Brazil, from December 2020 to July 2021. METHODS: The collection was carried out through questionnaire and analysis of medical records. Data were analyzed descriptively, as well as Pearson's chi-square test or Fisher's exact test. RESULTS: Among the patients, 88.6% were male, 47.5% were between 18 and 29 years old, and 59.6% lived in rural areas; 72.15% of the victims used the motorcycle for work and 43.52% were working at the time of the accident. Most victims did not have a national motorcycle license (62%) and were not wearing a helmet at the time of the accident (60%), with 37.6% wearing a full-face helmet, 16.5% an open helmet, and 5.9% an articulated full-face helmet. Soft tissue injuries were the most prevalent. Zygomatic complex fractures were the most common facial fractures and were significantly associated with helmet use and type. CONCLUSIONS: Most victims of motorcycle accidents are young adult men, without a regular driver's license and residing in rural areas. Preventive and educational actions and continuous traffic inspections are necessary to minimize these accidents.

Epidemiology and patterns of gymnastics-related head & neck trauma injuries: A NEISS database study.

OBJECTIVE: To describe the epidemiology and patterns of gymnastics-related Head & Neck trauma injuries using the NEISS database from 2001 to 2020. STUDY DESIGN AND SETTING: Cross-sectional analysis of a national database. METHODS: Gymnastics-related ED visits between 2001 and 2020 were queried from the NEISS database. Bivariate chi-squared analyses were used to compare injury demographics, location, type, and disposition. Fracture location was identified using the narrative description of each case and were divided into subtypes for further analysis. RESULTS: 1455 gymnastics-related head and neck traumatic injuries were identified. The majority were in females (65.8%). The most common presenting age group was pediatric (≤18 years) (92.7%), and the largest racial group was Caucasian (51.5%). Of all location subtypes, facial injuries were the most common presenting injury type overall (45.2%). Regarding injury types, lacerations were most common (36.8%), followed by dental injury (30.7%) and fractures (21.2%). The most common location of head and neck fractures was the nose (45.8%), followed by cervical spine (16.7%) and orbit (13.3%). The majority (95.7%) of gymnastics-related head and neck traumatic injuries presenting to the ED were treated and discharged. CONCLUSION: This study characterizes gymnastics-related head and neck injuries which is a topic that is under-studied. The findings from this study are helpful for gymnasts and those who care for them including providers, coaches and guardians, and this data may help inform future guidelines for treatment and injury prevention.

Facial trauma in the major league baseball.

OBJECTIVE: The objectives of this study were to identify and describe significant facial trauma present in Major League Baseball (MLB) that resulted in players missing games or being placed in the injury reserve list. STUDY DESIGN: This was a retrospective cohort study. The predictor variables were the player's age, height, weight, body mass index, position, team conference, and if played games took place in playoffs season. The outcome variables were injury location (upper, middle, and lower facial third) and type of injury (soft tissue, fracture). Chi-square and logistic regression were computed to determine associations between predictor and outcome variables. RESULTS: A total of 109 players missed games due to facial injuries, and a total of 115 injuries were identified. Of the 115 injuries, none occurred in the upper facial third, 96 (83%) were in the middle third, and 19 (17%) in the lower third. Most fractures occurred in fielders (45%), and most soft tissue injuries in basemen (40%). CONCLUSIONS: Significant facial trauma in the MLB has risen in recent years. The player's height, conference, and playoff season were the most associated factors. Most injuries occurred in the periorbital area. A recommendation for the use of protection goggles can be made to prevent them.

Assessment of health-related quality of life in patients with burns injuries during the COVID-19 epidemic: A critical topic for burn survivors.

PURPOSE: It is well known that the coronavirus disease 19 (COVID-19) epidemic had an adverse effect on the health-related quality of life (HRQOL) of patients with disabilities, or neurological or chronic conditions. The aim of this study was to examine the possible factors affecting HRQOL in patients with burn injuries during COVID-19 epidemic. METHODS: The study included a total of 40 burns patients. The demographic and burn injury information of the patients were recorded. The active range of motion was measured with a goniometer. The HRQOL, community integration, scar tissue quality and anxiety level were evaluated using the Burn-Specific Health Scale (BSHS), the Community Integration Questionnaire Revised (CIQ-R), Patient and Observer Scar Assessment Scale, and the State-Trait Anxiety Inventory, respectively. RESULTS: The history of COVID-19 infection, total burn surface area (TBSA), community integration level, work-related burns, the presence of trunk burn injury, the presence of face burn injury, and the presence of a major burn injury were determined to be significantly associated with the HRQOL of burns patients (p < 0.05). CONCLUSION: The history of COVID-19 infection, community integration level, and burn-related parameters (TBSA, localization, severity etc.) were found to be factors associated with the HRQOL during the epidemic. The history of COVID-19 and community integration level should be evaluated in addition to the burn injury parameters to improve the quality of life of burn survivors. It can be recommended that these clinical parameters should be considered when planning the treatment program during and after the epidemic.

Eye Trauma in Mixed Martial Arts and Boxing.

PURPOSE: To evaluate and compare eye and face trauma in mixed martial arts (MMA) and boxing. DESIGN: Retrospective cohort study. METHODS: Data from boxing and MMA competitions were extracted from the Nevada Athletic Commission (NAC) between 2000 and 2020. Details of competitions, contestants, outcomes, and injuries were extracted. RESULTS: In total 1539 boxing injuries (from 4313 contests) and 1442 MMA injuries (from 2704 contests) were identified. Boxing had higher eye injury rates compared to MMA ( p < 0.0001), with an odds ratio of 1.268 (95% CI, 1.114-1.444). Eye trauma represented 47.63% of boxing injuries and 25.59% of MMA injuries, with periocular lacerations being the most common eye injury in both. Orbital fractures represented 17.62% of eye injuries in MMA and 3.14% in boxing contests. However, 2%-3% were retinal in both sports, and 3.27% were glaucomatous in boxing. MMA contestants had an odds ratio of 1.823 (95% CI, 1.408-2.359) for requiring physician evaluation following an eye injury compared with boxing. MMA contestants also had a higher rate of face ( p < 0.0001) and body ( p < 0.0001) injuries. For both sports, an increased number of rounds and being the losing fighter were associated with increased odds of eye and face injury. CONCLUSION: Although boxing has a higher rate of eye injuries, MMA eye injuries are more likely to require physician evaluation. MMA contestants also have a higher rate of orbital fractures and face and body trauma. A detailed postfight examination and long-term follow-up of ocular injury in combat sports will be vital in proposing reforms to prevent eye trauma.

Are severity and location of facial trauma risk factors for cervical spine injuries? 10-year analysis based on the use of the AO spine injury classification and the comprehensive facial injury (CFI) score.

PURPOSE: This study aims to demonstrate a correlation between cervical spine injury and location and severity of facial trauma. METHODS: We did a 10-year retrospective analysis of prospectively collected patients with at least one facial and/or cervical spine injury. We classified facial injuries using the Comprehensive Facial Injury (CFI) score, and stratified patients into mild (CFI < 4), moderate (4 ≤ CFI < 10) and severe facial trauma (CFI ≥ 10). The primary outcome was to recognize the severity and topography of the facial trauma which predict the probability of associated cervical spine injuries. RESULTS: We included 1197 patients: 78% with facial injuries, 16% with spine injuries and 6% with both. According to the CFI score, 48% of patients sustained a mild facial trauma, 35% a moderate one and 17% a severe one. The midface was involved in 45% of cases, then the upper facial third (13%) and the lower one (10%). The multivariate analysis showed multiple independent risk factors for associated facial and cervical spine injuries, among them an injury of the middle facial third (OR 1.11 p 0.004) and the facial trauma severity, having every increasing point of CFI score a 6% increasing risk (OR 1.06 p 0.004). CONCLUSIONS: Facial trauma is a risk factor for a concomitant cervical spine injury. Among multiple risk factors, severe midfacial trauma is an important red flag. The stratification of facial injuries based on the CFI score through CT-scan images could be a turning point in the management of patients at risk for cervical spine injuries before imaging is available.

Prevalence of orofacial injuries resulting from trauma in individuals with cerebral palsy: A systematic review and meta-analysis.

Individuals with cerebral palsy (CP) may have cognitive, sensitive, behavioral, communicative, and convulsive disorders. Because defensive reflexes are reduced by CP, the risk of orofacial trauma is greater in these individuals. This study aimed to evaluate the prevalence of orofacial injuries resulting from trauma in patients with CP. This review was reported according to preferred reporting items for systematic reviews and meta-analyses (PRISMA) and registered in the International Prospective Register of Systematic Reviews (PROSPERO-CRD42022293570). The search was performed for articles published until January 2023 in Embase, Latin American and Caribbean Literature on Health Sciences (LILACS), PubMed/Medline, Scopus, and Web of Science databases. Gray literature was also consulted through Google Scholar, OpenGrey, ProQuest Dissertations, and Theses. Studies in which orofacial injuries due to trauma were prevalent in individuals with CP were included. The risk of bias was assessed using the Joanna Briggs Institute Critical Appraisal Tool. Additionally, a random-effects meta-analysis was conducted. Twelve studies were included in the synthesis, of which nine presented a low risk of bias and three presented a moderate risk. When considering the general prevalence of orofacial injuries in patients with CP, a prevalence of 34% [95% CI = 18%-52%; I2 = 98%] was observed, with enamel and dentin fractures being the most common orofacial injuries. Approximately one in three patients with CP showed at least one type of orofacial injury involving dental trauma. There is a lack of literature assessing the prevalence of these traumas in soft tissues and the evidence for this outcome remains uncertain.

Covid lockdowns and hospitalisations for oro-facial trauma among children in Australia and the United Kingdom.

BACKGROUND/AIM: This retrospective study investigated the effect of lockdowns for Covid-19 on the rates of oro-facial trauma hospitalisations in children in Australia and the United Kingdom (UK). MATERIALS AND METHODS: Hospitalisation data for children up to 19 years old for oro-facial trauma injuries (according to ICD-10-AM principal diagnosis codes) over 5 years were collected for Australian and UK children. The age-standard rate (ASR) for each age group was calculated per 100,000 population. RESULTS: In the younger Australian children, there was no statistically significant change in the ASR of oro-facial trauma hospitalisations during the 'Covid year', compared to the average rate over the 3 years preceding. However, there was a significant decrease in the ASR of oro-facial trauma hospitalisations during the 'Covid year' in older Australian children (aged 10-19), and for all UK children, except for infants under one-year-old. CONCLUSIONS: Reduction of the ASR of hospitalisations due to oro-facial trauma during the 'Covid year', and the implementation of lockdown measures in the two countries provides further evidence of the impact of physical activities and travel as contributing factors to oro-facial injuries in children. In addition to its role in reducing the spread of virus infections during the pandemic, the lockdown measures also resulted in a simultaneous decrease in trauma injuries.

A 10-Year Retrospective Review of Playground-Associated Craniofacial Injuries in the Pediatric Patient Population.

This retrospective study utilized the National Electronic Injury Surveillance System (NEISS) database to identify pediatric emergency department (ED) patients with playground-associated craniofacial injuries between January 2012 and December 2021. A total of 25 414 patients were identified. The majority of injuries occurred in preschool and elementary school-age children (90.3%) and patients were more commonly boys (59.3%). Injuries most often involved the head/scalp (52.4%), face (30.4%), and mouth (11.9%). Infant (32.7%) and teen (40.0%) injuries most commonly involved swings, whereas preschool (23.1%) and elementary school (28.1%) injuries were mostly associated with slides and climbers, respectively. Most patients were treated in the ED and discharged to home (96.5%), a small portion required hospitalization (1.6%), and one death was reported. Although the majority of the injuries were relatively minor and resulted in same-day discharges, these injuries can result in serious physical harm, emotional stress, and unexpected financial burdens. Proper education and supervision regarding safe play is important to prevent these injuries.

COVID-19 impact on facial trauma: Insights from Mississippi's only level 1 trauma center.

PURPOSE: Our primary aim was to understand and describe the impact of COVID-19 on the incidence and etiology of facial trauma in the state of Mississippi. METHODS: Retrospective review of facial trauma-related Emergency Department encounters in Mississippi from March 11, 2019 to March 10, 2021, divided into three time periods using the state of Mississippi's Governor's Office Executive Orders. Chi-square tests and segmented linear regressions were used for analysis. RESULTS: Patients presenting with facial trauma were typically male, 18-44 years old, and lived in urban zip codes. Insurance payors significantly differed across time periods. There were no significant differences in self-inflicted assault or accidental injury between the 3 time periods, with pre- and pandemic patients more likely to be self-pay while patients during recovery being more likely to have private insurance. During the pandemic, facial trauma from a family member, partner or spouse, or other person in the household significantly increased. CONCLUSION: Similar accidental facial trauma trends may reflect lower adherence to social distancing guidelines. The increase in facial trauma perpetrated by family members is consistent with reported increases in domestic violence during the pandemic. While overall facial trauma demographic patterns did not change significantly during the COVID-19 pandemic, there were notable changes in the etiology and insurance payor of facial trauma cases. LAY SUMMARY: The COVID-19 pandemic impacted healthcare systems worldwide, and our study seeks to understand how the pandemic affected incidence of facial trauma.

Facial Injuries in the National Basketball Association.

BACKGROUND: Sport injuries can negatively impact physical and psychological aspects of athletes. There is a gap in the literature regarding facial trauma present in basketball. PURPOSE: The purpose of this study is to identify and describe facial trauma present in the National Basketball Association (NBA). STUDY DESIGN, SETTING, SAMPLE: This is a retrospective cohort study in which the sample (n = 206) consists of players that missed games due to facial injuries in the NBA, the data were collected from a public access online resource. INDEPENDENT VARIABLE: The predictor variables were player position (center, point guard, shooting guard, small forward, and power forward), team conference (Eastern/Western), and if played games occurred in playoff season. MAIN OUTCOME VARIABLES: The primary outcome variable was the injury location (upper, middle, and lower facial third), and the secondary outcome was type of injury (soft tissue/bone fracture). COVARIATES: Player's age, height, weight, and body mass index were collected. ANALYSES: χ2 and logistic regression were calculated to determine associations between predictor and outcome variables. Logistic regression was used to determine if variables were predictive for injury. Odds ratio was also computed for significant results. P value less than .05 (95% confidence interval) was considered statistically significant. RESULTS: A total of 206 players missed games due to facial injuries, and a total of 212 injuries were quantified. The mean age of the injured players was 27.24 ± 4.06 years, mean height (centimeters) was 201 ± 59.31 cm, mean weight (kilograms) was 99.48 ± 12.41 kg, and body mass index was 24.52 ± 1.75 kg/m2. Of the 212 injuries, none of them occurred in the upper facial third, 158 (75%) were in the middle third, and 54 (25%) were in the lower third; 151 of them were fractures (61%) and 61 were soft tissue injuries (29%). Most injuries were concentrated in centers (23%) and power forwards (23%). The most common fracture occurred in the nasal bones (39.2%), and most soft tissue injuries occurred in the eye globes (25%). Almost all injuries occurred during regular season games (97%), and the Eastern conference was slightly predominant (52%). CONCLUSION AND RELEVANCE: Significant facial trauma in the NBA has risen in recent years. The player's position, height, and weight were the primary factors associated with facial trauma in the NBA.

E-cigarette explosion injuries in the oral and maxillofacial region and a protocol for their management.

DATA SOURCES: MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Central Register of Controlled Trials, Embase and Web of Science along with the reference lists from select articles. STUDY SELECTION: Retrospective or prospective cohort studies, randomised controlled trials, case series, case-control studies and case reports on e-cigarette explosion-related facial injuries published in the English language were included. Review articles, nonclinical studies, commentaries, published abstracts and editorials were excluded. Also were excluded, those studies which did not specify injury location or if the injury did not pertain to the maxillofacial region. DATA EXTRACTION AND SYNTHESIS: Data pertaining to bibliographic information, device characteristics, patient details, facial injuries, factors precipitating explosion, complications at follow-up, management and other injuries were extracted. An association between the predictor variables of injury type and location with outcomes of surgical management and intubation was determined by utilising a Chi-squared analysis. RESULTS: A total of 28 studies met the inclusion criteria. A total of 105 facial injuries in 32 patients from 32 e-cigarette explosions were recorded. 73.3% of the injuries were projectile in nature with 26.7% being characterised by burns. 43.8% of all patients suffered both burn and projectile injuries. The eye (10.7%), oral cavity (25%) and face (64.3%) were involved with burn injuries. Projectile injuries mostly involved the lower third of the face (81.8%). 62.5% of patients suffered from a tooth or bone fracture. A 44.4% rate of complications was reported amongst the studies which reported on follow-ups. Surgical management or intubation were found to have no statistically significant relationship with explosive oral injuries. No other statistically significant associations were observed between outcomes and other injury types. CONCLUSIONS: There is a risk of spontaneous combustion with e-cigarettes, which can cause injuries of a serious nature to the oral and maxillofacial region, specially the lower third of the face, commonly necessitating surgical management. Increased regulation along with user education are required in order to improve the safety profile of these devices.

Trends in Soccer-Related Craniomaxillofacial Injuries, United States 2003-2022.

BACKGROUND: Soccer is one of the most popular sports worldwide. However, it has risks of injury to craniomaxillofacial regions such as the head, neck, and mouth. PURPOSE: The purpose of this study is to determine which demographic and injury characteristics among soccer players with craniomaxillofacial injuries are associated with increased hospitalizations. STUDY DESIGN, SETTING, AND SAMPLE: This is a retrospective cohort study utilizing the National Electronic Injury Surveillance System. Subjects included in this study experienced an injury to a craniomaxillofacial area from soccer between January 1, 2003, and December 31, 2022. PREDICTOR VARIABLE: The predictor variables included demographics (age, sex, race) and injury characteristics (craniomaxillofacial region, diagnosis). MAIN OUTCOME VARIABLE: The primary outcome variable was injury severity defined as hospitalization outcome after injury (yes/no). The secondary outcome variable was the trends in the incidence of soccer craniomaxillofacial injuries over time (2003-2022). COVARIATES: The covariates were the heterogenous set of predictor variables in this study. ANALYSES: Descriptive statistics and univariate analyses were computed. Survey-weighted univariate and multivariate logistic regression were used to measure the association of demographic and injury variables with hospitalization outcome. Statistical significance was defined as P < .05. RESULTS: The study sample included 26,642 subjects (national estimate, 799,393). The national incidence of craniomaxillofacial soccer injuries generally increased between 2003 and 2012 and decreased between 2016 and 2020. Subjects in the ≥30 age group had increased odds of hospitalization compared to those in the 10-19 age group (odds ratio [OR], 2.12; P < .001). Compared to females, males had significantly higher odds of hospitalization (OR, 1.53; P < .001). Head (OR, 8.42; P < .001) and neck (OR, 15.8; P < .001) injuries had increased odds of hospitalization compared to facial injuries. Relative to contusions/abrasions, subjects with fractures (OR, 94.7; P < .001), dental injuries (OR, 41.3; P < .001), and concussions (OR, 5.33; P = .017) were at significantly higher odds of hospitalization. CONCLUSION AND RELEVANCE: Age, sex, craniomaxillofacial region, and diagnosis were significant predictors of hospitalization outcome after craniomaxillofacial soccer injury. Safer playing styles, use of mouthguards, and proper medical management may reduce future risks of craniomaxillofacial injury from soccer.

Incidence of facial fractures in association with facial laceration from dog bites in the pediatric patient.

INTRODUCTION: Dog bite injuries occur in approximately 102 of every 100,000 population. Pediatric facial injuries due to dog bites are more common than in the adult largely due to height difference and ease of access for the dog to the head and neck region. Although majority are soft tissue injuries, pediatric facial fractures from dog bites are estimated at approximately 5%, with the true incidence unknown. We hypothesize that depth and facial subsite of laceration can indicate likelihood of facial fracture presence in pediatric patients with dog bite injuries. METHODS: This single-institution retrospective study included 162 patients 18 years or younger (n = 162) who had an ICD-9 code of E906.0 or ICD-10 code of W54.0 for dog bites in the head and neck region between 1/1/2015 and 12/31/2019 and were treated in the emergency department by either an emergency department, otolaryngology, or plastics surgery provider. Multivariable logistic regressions were used to examine the association between patient age, sex, and dog size, and the outcomes: laceration depth (epidermis, dermis, muscle, bone), and facial subsite (upper, middle, lower third). RESULTS: Males had a lower laceration penetration at the epidermis level (aOR = 0.36; 95% CI 0.19, 0.69) but a higher laceration penetration at the muscle level (aOR = 2.29; 95% CI 1.04, 5.04) compared to females. No significant findings were observed for the levels of dermis and bone. In the multivariable analysis, there were no significant associations to suggest facial fractures found between facial subsites and age, sex and dog size. CONCLUSION: No significant associations between depth or facial subsite of facial injury from dog bites and the presence of facial fractures in pediatric patients except with regard to male sex and laceration level of epidermis and muscle.

Epidemiology and Etiology of Facial Injuries in Children.

Pediatric Trauma results in over 8 million emergency department visits and 11,000 deaths annually. Unintentional injuries continue to be the leader in morbidity and mortality in pediatric and adolescent populations in the United States. More than 10% of all visits to pediatric emergency rooms (ER) present with craniofacial injuries. The most common etiologies for facial injuries in children and adolescence are motor vehicle accidents, assault, accidental injuries, sports injuries, nonaccidental injuries (eg, child abuse) and penetrating injuries. In the United States, head trauma secondary to abuse is the leading cause of mortality among non-accidental trauma in this population.

Knowledge of traumatic dental injuries and mouthguard behavior among Croatian soccer players.

OBJECTIVES/AIM: Sports-related dental injuries occur frequently among athletes due to inadequate knowledge and prevention measures. The aim of the study was to assess knowledge, attitudes, and practices of active soccer players from all leagues in Croatia regarding traumatic dental injuries and the use of mouthguards. MATERIAL AND METHODS: 393 respondents completed a questionnaire-based online survey from March 2022 to April 2022. The questionnaire consisted of 37 questions divided in four sections: demographic characteristics, experience with orofacial injuries, knowledge of emergency therapeutic procedures for dental injuries, and behaviors related to the use of a mouthguard. RESULTS: Insufficient knowledge was confirmed by a total score of 2.8 ± 2.8 points, with a possible maximum of 11. Respondents' better knowledge can be associated with educational level (p = .002), playing position (p = .046), and personally experienced injuries to the face and jaw (p ≤ .001) and teeth (p = .022). Less than 40% of respondents suffered facial and jaw injuries while playing football and 18.6% suffered dental injuries. Although most respondents (93.9%) were familiar with mouthguards and 68.9% believed that they help prevent injuries while playing football, only 16% used them. CONCLUSION: The study revealed significant gaps in knowledge regarding dental injuries and the practice of mouthguard usage among Croatian soccer players. Therefore, it is evident that additional education is needed to prevent dental injuries and take proper procedures when taking care of them among the examined population.