Perfil epidemiológico do trauma facial em um hospital regional do interior da bahia / Epidemiological profile of facial trauma at a regional hospital in the interior of Bahia / Perfil epidemiológico de trauma facial en un hospital regional del interior de Bahia

Introdução:Estudos retrospectivos sobre trauma facial são importantes para quantificar sua demanda para os serviços de saúde, além de contribuir parao planejamento de ações de educação e prevenção. Objetivo:Este estudo teve por objetivo traçar o perfil epidemiológico do trauma facial em um hospital regional do interior da Bahia. Metodologia:Realizou-se um estudo descritivo, transversal, por meio de análise retrospectiva dos prontuários de pacientes vítimas de trauma facial, atendidos no Hospital Geral Prado Valadares, em Jequié-Bahia,Brasil,durante o período de janeiro de 2012 a dezembro de 2014.A análise estatística foi descritiva, sendo calculada em proporções e frequências absolutas e relativas.Para a comparação entre as variáveis foi realizado o teste do Qui-quadrado ou teste exato de Fisher.Resultados:Foram analisados 499 prontuários e observou-se que o sexo masculino (81,6%) e a etnia parda (50,3%) foram os mais acometidos pelo trauma facial. A faixa etária de maior prevalência foi de 25 a 34 anos (25,5%).O principal fator etiológico foi o acidente por motocicleta (30,1%) e houve elevada prevalência de traumatismo cranioencefálico (33,5%).Conclusões:No período estudado, verificou-se que indivíduos do sexo masculinoeadultos jovens foram os mais acometidos pelo trauma facial. Os traumas relacionados aos acidentes de motocicletae quedaforam os mais prevalentes (AU).

Introduction:Retrospective studies on facial trauma are important to quantify their demand for health services, in addition to contributing to the planning of education and prevention actions. Objective:This study aimed to trace the epidemiological profile of the facial trauma at a regional hospital in the interior of Bahia. Methodology:A descriptive, cross-sectional study was carried out through the retrospective analysis of medical records of patients who were victims of facial trauma, attended at the Prado Valadares General Hospital, Jequié-Bahia, Brazil, during the period from January 2012 to December 2014. The statistical analysis was descriptive, being calculated in absolute and relative proportionsand frequencies. The Chi-square test or Fisher's exact test were used to compare the variables.Results:499 medical records were analyzed and it was observed that males (81.6%) and mixed race (50.3%) were the most affected by facial trauma. The most prevalent age group was 25 to 34 years old (25.5%). The main etiological factor was the motorcycle accident (30.1%) and there was a high prevalence of traumatic brain injury (33.5%). Conclusions:During the study period, it was found that male individuals and young adults were the most affected by facial trauma. Traumas related to motorcycle accidents and falls were the most prevalent (AU).

Introducción: Los estudios retrospectivos sobre trauma facial son importantes para cuantificar su demanda de servicios de salud, además de contribuir a la planificación de acciones de educación y prevención. Objetivo: Este estudio tuvo como objetivo rastrear el perfil epidemiológico del trauma facial en un hospital regional del interior de Bahía. Metodología: Se realizó un estudio descriptivo, transversal, mediante un análisis retrospectivo de las historias clínicas de pacientes con trauma facial atendidos en el HospitalGeral Prado Valadares, en Jequié-Bahia, Brasil, desde enero de 2012 a diciembre de 2014. El análisis estadístico fue descriptivo, siendo calculado en proporciones y frecuencias absolutas y relativas. Para comparar las variables se utilizó la prueba de Chi-cuadrado o la prueba exacta de Fisher. Resultados:se analizaron 499 historias clínicas y se observó que los hombres (81,6%) y mestizos (50,3%) fueron los más afectados por el traumatismo facial. Elgrupo de edad más prevalente fue el de 25 a 34 años (25,5%). El principal factor etiológico fue el accidente de motocicleta (30,1%) y hubo una alta prevalencia de traumatismo craneoencefálico (33,5%). Conclusiones: Durante el período de estudio, se encontró que los hombres y los adultos jóvenes fueron los más afectados por el trauma facial. Los traumatismos relacionados con accidentes de motocicleta y caídas fueron los más prevalentes (AU).

Secondary overtriage of isolated facial trauma.

DESIGN: Retrospective chart review. SETTING: Academic, tertiary care, level I trauma center in a rural state. BACKGROUND: Unnecessary transfer of certain facial trauma patients results in a burden of time, money, and other resources on both the patient and healthcare system; identification and development of outpatient treatment pathways for these patients is a significant opportunity for cost savings. OBJECTIVES: To investigate the treatment and disposition of un-complicated, stable, isolated facial trauma injuries transferred from outside hospitals and determine the significance of secondary overtriage. METHODS: Retrospective chart review utilizing our institutional trauma database, including patients transferred to our emergency department between January 2012 and December 2017. Patients were identified by ICD9 or ICD10 codes and only those with isolated facial trauma were included. RESULTS: We identified 538 isolated facial trauma patients who were transferred to our institution during the study period. The majority of those patients were transferred via ground ambulance for an average of 76 miles. Overall, 82% of patients (N = 440) were discharged directly from our institution's emergency department. Almost 30% of patients did not require any formal treatment for their injuries; the potential savings associated with elimination of these unnecessary transfers was estimated to be between $388,605 and $771,372. CONCLUSIONS: We identified a high rate of patients with stable, isolated facial trauma that could potentially be evaluated and treated without emergent transfer. The minimization of these unnecessary transfers represents a significant opportunity for cost and resource utilization savings. LEVEL OF EVIDENCE: 2b- Economic and Cost Analysis.

Atendimento ao trauma de face por telemedicina: validação de modelo de videoconferência com uso de smartphone e análise da concorância com atendimento presencial / Facial trauma assessment through telemedicine: validation of a videoconference via smartphones model and analysis of agreement between telemedicine and face-to-face attending

As dimensões continentais de alguns países e a distribuição heterogênea da rede hospitalar dificultam o acesso ao atendimento inicial adequado ao trauma de face principalmente aos pacientes residentes em regiões mais remotas. Um modelo de atendimento por telemedicina pode ser uma opção ao atendimento especializado presencial. Os objetivos deste trabalho são apresentar um modelo de atendimento por especialistas à distância, por meio de videoconferência utilizando-se smartphone, e analisar a concordância deste atendimento por telemedicina com o atendimento presencial, considerado padrão ouro. Cinquenta pacientes com trauma de face e suspeita de fratura de face (n=50) foram atendidos, por duas equipes independentes, uma presencialmente e outra por telemedicina. A equipe presencial, que era formada pela equipe de plantão de cirurgia plástica na unidade de emergência, prestou o atendimento à beira do leito (história, exame físico e análise de imagens por tomografia computadorizada). A equipe telemedicina, composta por um médico generalista atendendo à beira do leito, prestou atendimento em conjunto com um cirurgião plástico à distância através de videoconferência com um smartphone. Após cada atendimento as duas equipes responderam a um questionário, com informações sobre dados epidemiológicos, dados do exame físico, sobre indicações de tomografia computadorizada, achados radiológicos da tomografia e conduta. Os dados foram analisados e comparados quanto à concordância das respostas através da análise estatística kappa, cálculo de acurácia, especificidade e sensibilidade. A amostra estudada foi representativa e concordante com a literatura, com predomínio de homens jovens. Acidentes de trânsito e violência interpessoal foram os principais mecanismos causadores do trauma. A concordância das respostas para os achados de exame físico foi considerada substancial (kappa=0,720), para a indicação da tomografia computadorizada foi quase perfeita (kappa=0,957), para os...

The continental size of some countries and heterogeneous distributed hospital network prevent many patients who live in remote areas from getting adequate initial assessment of facial trauma. The author presents a model for trauma assessment through telemedicine, which may be an alternative to face-to-face specialized attending. The goals of this study are presenting a model for non-attending specialized assessment through video conference via smartphones, and analyzing a comparison between telemedicine and face-to-face management, the latter currently being the gold standard. Fifty patients with either a confirmed or suspected diagnosis of facial trauma (n=50) were evaluated by two teams of physicians, one face-to-face and the other one telemedicine-based. The face-to-face team, which was made up by the attending plastic surgery team in the emergency unit, attended the patients at the bedside (physical examination and CT-scan analysis). The telemedicine team was made up by an in-house general practitioner working together with an on-call plastic surgeon through videoconference via smartphones. After each evaluation, both teams answered a similar questionnaire, which contained data concerning the patient's epidemiology, physical examination, CT-scan indications and findings, and the treatment option to be followed. The data were analyzed and compared regarding the similarity of answers, with the use of kappa statistics and analysis of data accuracy, sensitivity and specificity. The sample studied was representative and consistent with the literature, showing a predominance of young males. Traffic accidents and personal violence were the main causes of trauma. The agreement of answers for physical examination findings was considered substantial (kappa=0.720). For CT-scan indications, it was considered almost perfect (kappa=0.957); for CT-scan findings, it was almost perfect (kappa=0.899); and for defining the treatment option, it was...

Systematic assessment of the patient with facial trauma.

The systematic assessment of patients with facial injuries is the culmination of wisdom from trials and errors, audits of failures and successes, careful and mindful reflection of current practice, and a willingness to change. Emerging technology has positively impacted the practice of management of facial trauma. A systematic evaluation and physical examination of the trauma victim remain the gold standard and the first step toward effective care.

Pediatric facial trauma: a review of guidelines for assessment, evaluation, and management in the emergency department.

Approximately 22 million children in the United States sustain traumatic injuries every year, the etiologies of which vary with age as well as social and environmental factors. If not managed properly, these injuries can have a significant impact on future growth and development. Evaluation of facial injuries presents a unique diagnostic challenge in this population, as differences from adult anatomy and physiology can result in vastly different injury profiles. The increased ratio of the cranial mass relative to the body leaves younger patients more vulnerable to craniofacial trauma. It is essential that the treating physician be aware of these variations to properly assess and treat this susceptible and fragile patient population and ensure optimal outcomes. This article reviews the proper emergency department assessment and treatment of facial fractures in the pediatric population as well as any associated injuries, with particular emphasis on initial patient stabilization, radiological evaluation, and therapeutic options.

Avaliação odontolegal das lesões corporais que envolvem o complexo maxilomandibular causadas por acidentes de trânsito / Forensic dental assessment of body injuries involving the maxillomandibular complex caused by traffic accidents

As lesões corporais originárias de acidentes de trânsito comumente afetam a cavida- de bucal causando prejuízos funcionais e estéticos. O objetivo deste estudo foi avaliar as lesões do complexo maxilomandibular ocasionadas por acidentes automobilísticos. Foram analisados 565 laudos emitidos pelo Núcleo de Odontologia Legal do Instituto Médico Legal de São Paulo (lML!SP) durante os anos de 2004 a 2007, coletando-se informações referentes ao gênero das vítimas, faixa etária e gravidade das lesões em conformidade com o artigo 129 do Código Penal. Os resultados demonstraram predomínio no número de acidentes em jovens do gênero masculino e com idade inferior à 29 anos em todos os anos analisados. As lesões de gravidade leve foram superiores perante as graves e gravíssimas, quando relacionadas ao complexo maxilomandibular. Dessa forma, os resultados demons- tram a certeza da necessidade de intervenções em âmbito governamental e individual, visando à redução de acidentes automobilísticos e consequentemente minimizando danos ao sistema estomatognático.

The body injuries which result from traffic accidents commonly affect the oral cavity causing functional and aesthetic impairment. The aim of this study was to evaluate the maxillomandibular complex lesions caused by automobile accidents. It has been analyzed 565 reports on the Center for Forensic Dentistry of Forensic Medicine Institute of Sao Pau- lo, IML-SP during the period from 2004 to 2007, collecting information about the gender of victims, age and degree of injuries. The results showed a predominance in the number of accidents in young males and with ages lower than 29 years old in ali the years analyzed. The mild lesions were higher when comparing them with the serious and very serious, ali related to the maxillomandibular complex. Thus, the results demonstrate the certainty of the need for interventions in the governmental and individual actions in order to reduce accidents and therefore minimizing damages to the stomatognathic system.

Utility scores for facial disfigurement requiring facial transplantation [outcomes article].

BACKGROUND: Controversy exists as to whether the benefits of facial transplantation outweigh the risk of continuous immunosuppression. Utility scores [range, 0 (death) to 1 (perfect health)] are a standardized tool with which to objectify health states or diseases and can help answer such controversy. METHODS: An Internet-based utility assessment study using visual analogue scale, time trade-off, and standard gamble was used to obtain utilities for facial disfigurement requiring facial transplantation from a sample of the general population and medical students at McGill University. Average utility scores were compared using t test, and linear regression was performed using age, race, and education as independent predictors of each of the utility scores. RESULT: A total of 307 people participated in the study. All measures (visual analogue scale, time trade off, and standard gamble) for facial disfigurement (0.46 + or - 0.02, 0.68 + or - 0.03, and 0.66 + or - 0.03, respectively) were significantly different (p < 0.001) from the corresponding ones for monocular blindness (0.62 + or - 0.02, 0.83 + or - 0.02, and 0.82 + or - 0.02, respectively) and binocular blindness (0.33 + or - 0.02, 0.62 + or - 0.03, and 0.61 + or - 0.03, respectively). Age was inversely proportional to the utility scores in all groups (p < 0.01), decreasing a utility score of 0.006 for every increase in year of age. CONCLUSION: A sample of the general population and medical students, if faced with facial disfigurement, would undergo a face transplant procedure with a 34 percent chance of death and be willing to trade 12 years of their life to attain perfect health.

Emergency department assessment and management of facial trauma from war-related injuries.

Facial trauma related to combat injury is of increasing prevalence and complex in nature when associated with the multiply injured trauma victim. Although rarely life-threatening, the treating physician must be aware of the presence of facial trauma and its associated injuries to seamlessly treat the combat casualty in accordance to the Advanced Trauma Life Support protocol while maintaining the armed forces' ultimate goals of returning "the greatest possible number of soldiers to combat and the preservation of life, limb and eyesight in those who must be evacuated." To this end, the treating physician must maintain a high index of suspicion for injury and have various maneuvers available to handle immediate threats to life, limb, or sight. This article will review the proper emergency department assessment and management of prevalent injuries associated with war-related facial trauma.

Soft tissue injuries to face and neck: early assessment and repair.

The principles of assessment and repair of soft tissue trauma of the face are outlined. The importance of an adequate preoperative evaluation is emphasized. Recognizing lesions in the deep vital structures is extremely important in the initial approach to these patients. The postoperative care and the best management of the sequelae are described.

Knowledge and attitudes among California dental care providers regarding child abuse and neglect.

The authors surveyed California dentists about their knowledge, attitudes and practices regarding child abuse and neglect. Only 16 percent of the respondents claimed to have seen or suspected a case of child abuse or neglect during the preceding five years, and only 6 percent claimed to have reported such a case. The authors also found that the respondents had little knowledge of California law regarding the reporting of such cases and little information or training in diagnosing and reporting suspected child abuse and neglect.

Orofacial trauma management. Patient assessment and documentation.

New technologies and treatments for managing children with orofacial trauma are constantly updated and available to the practitioner through current literature. What often fails to be appreciated, however, is that orofacial injury is a subset of head trauma and may have systemic emergent considerations that supersede the oral conditions being addressed. The complexity of a thorough assessment of the child from both medical and dental standpoints requires a systematic approach, which in turn can be guided by an appropriate document for inclusion in the chart. Further, such a document will serve as an important record should future civil litigation ensure from the traumatic incident.

Facial trauma. Assessment and treatment.

Management of facial trauma requires immediate attention to patency of the airway and to circulation. This article outlines an assessment procedure for patients with facial injuries and presents treatment guidelines.

Facial form and function: films versus physical examination.

Criteria for the use of radiography for facial trauma in the emergency department have not been the subject of any critical reviews. Many recent reviews have been done on the advantages of various radiologic techniques to delineate specific facial injuries, both bony and soft tissue. No prospective study has addressed the criteria for ordering radiographs in the ED. Ideally the criteria would need only to consider the utility of studies in making therapeutic decisions. Unfortunately other considerations are involved, such as cost, medicolegal liability, and the real and imagined risks of radiation exposure. The intelligent use of radiologic examinations must be based on a thorough history and physical examination, a knowledge of the likely bony and soft tissue injuries, and an understanding of their concomitant physical signs and symptoms. In addition, the treating physician must know the options available in the radiology department.