Epidemiology of facial injury in female blunt assault trauma cases

The Upper Paralimbal Zone is Especially Susceptible to Ruptures Due to Blunt Trauma

BACKGROUND

Globe ruptures are ophthalmological emergencies where the primary diagnosis using a slit lamp is often a challenge.

OBJECTIVES

The retrospective case study aimed to characterise the predilection sites, the demographic profile and the causes of bursts due to blunt globe trauma.

MATERIALS AND METHODS

The surgical plan of the Eye Centre of the Medical Centre (University of Freiburg) was electronically searched using the keyword "globe rupture" over a period of 18 years (2000 - 2018). This led to 350 hits, which were scrutinised by hand. 134 globe ruptures due to blunt globe trauma were then identified.

RESULTS

The most common predilection sites were the upper nasal and the upper temporal paralimbal zones with 37 and 32% of the examined globe ruptures, respectively. The average age at the time of rupture was 60 (from 2 to 97) years. The median age was 62.5 years. 37% (49/134) of patients were female. The most frequent causes of accidents were falls (43%), "flying" wooden and metal objects (18%) and acts of violence (10%).

CONCLUSIONS

Special attention should be paid to the upper paralimbal zone in the exploratory primary care of globe ruptures. If the rupture occurred due to "flying" wooden and metal objects, the posterior sclera burst most frequently. The epidemiological data suggest that targeted prevention against falls for individuals over 60 years and consistent wearing of protective eyewear when working with wood or metal could reduce the incidence of bulbar bursting. It was also noticeable that acts of violence were the third most frequent cause of rupture, although woman did not report that they were affected by this. Given the high occurrence of violence against women, shame and stigma may lead to an incorrect inquiry about the cause of the accident. This could be mitigated by training employees specifically to take a sensitive history.

Characteristics of violence against women in Kairouan, Tunisia, in 2017

Violence against women represents a serious concern worldwide. In Tunisia, despite an advanced legislative framework, we still receive women victims of violence. This survey aimed to characterize the demographic and clinical profile of women victims of violence in Kairouan, central Tunisia. This survey was designed as a cross-sectional study. It concerned women victims of violence over 18 years old, consulting the emergency department of the University Hospital of Kairouan during 3 months in 2017. We defined violence against women according to the Tunisian protection of gender discrimination law. This survey included 100 Tunisian victims of violence; their median age was 35 (ranging from 18 to 59 years old). This study showed that 58% of victims, CI95% [48.3%, 67.6%], were illiterate or had only a primary level education and that 90%, CI95% [84.1%, 95.8%], had a low or middle socioeconomic level. The Intimate Partner Violence was about 70% among all cases, CI 95% [61.0%, 78.9%]. Most aggressive partners were young (aged between 39 and 51 years old). The most affected part of the body was the face (76%, CI 95% [67.6%, 84.3%]). Alcohol consumption was the primary risk factor of violence in 29.6% of cases, CI95% [20.0%, 37.9%]. Other risk factors were the occupational instability, conflicts with the family in-laws and infidelity. Violence against women remains widespread. Even strict legislations in Tunisia didn’t protect women sufficiently from different types of violence. It mostly happens within intimate relationships. Therefore, surveillance and early intervention controlling risk factors are extremely important.

Intimate Partner Violence: A Primer for Radiologists to Make the "Invisible" Visible

Intimate partner violence (IPV) is the physical, sexual, or emotional violence between current or former partners. It is a major public health issue that affects nearly one out of four women. Nonetheless, IPV is greatly underdiagnosed. Imaging has played a significant role in identifying cases of nonaccidental trauma in children, and similarly, it has the potential to enable the identification of injuries resulting from IPV. Radiologists have early access to the radiologic history of such victims and may be the first to diagnose IPV on the basis of the distribution and imaging appearance of the patient's currrent and past injuries. Radiologists must be familiar with the imaging findings that are suggestive of injuries resulting from IPV. Special attention should be given to cases in which there are multiple visits for injury care; coexistent fractures at different stages of healing, which may help differentiate injuries related to IPV from those caused by a stranger; and injuries in defensive locations and target areas such as the face and upper extremities. The authors provide an overview of current methods for diagnosing IPV and define the role of the radiologist in cases of IPV. They also describe a successful diagnostic imaging-based approach for helping to identify IPV, with a specific focus on the associated imaging findings and mechanisms of injuries. In addition, current needs and future perspectives for improving the diagnosis of this hidden epidemic are identified. This information is intended to raise awareness among radiologists, with the ultimate goal of improving the diagnosis of IPV and thus reducing the devastating effects on victims' lives. ^©RSNA, 2020.

Comparing Urban Maxillofacial Trauma Patterns to the National Trauma Data Bank©

OBJECTIVES

We aimed to determine whether certain maxillofacial fracture patterns and injury mechanisms were more prevalent in an urban environment. In addition, we aimed to determine if maxillofacial trauma incidence correlated with income.

METHODS

Data was collected from Einstein Healthcare Network and Temple University Health System. These data were compared to the 2016 National Trauma Data Bank© (NTDB©) using chi-square analysis. Multivariate analysis was used to identify correlations between demographic variables and fracture patterns. Sociodemographic data was further characterized utilizing neighborhood mapping.

RESULTS

A total of 252 patients from our urban campuses and 14 447 patients from the NTDB© were identified with facial fractures. Maxillofacial trauma patients in the urban population were more likely to be minorities and less likely to be Caucasian compared to the NTDB© (P < .001). Patients in the urban setting were more likely to sustain mandibular and orbital fractures, and less likely to sustain maxillary fractures and multiple fractures (P < .001). Urban maxillofacial trauma patients were more likely to sustain assault and sporting injuries, and less likely to sustain injuries from motor vehicle accidents and self-harm (P < .001).

CONCLUSIONS

Maxillofacial trauma patterns and injury mechanisms were shown to be significantly different in an urban environment as compared to national data.

Intimate partner violence in ophthalmology: a global call to action

PURPOSE OF REVIEW

Intimate partner violence (IPV) is a leading cause of death and disability worldwide. Despite increasing public awareness of IPV, little information is available regarding the prevalence, associated injury patterns, and impact of IPV as a mechanism of ocular and orbital trauma. The purpose of this review is to summarize the literature regarding the impact of IPV in ophthalmology and provide team members with guidance on appropriate practices for screening and referral.

RECENT FINDINGS

Data from 48 population-based studies estimates that the lifetime prevalence of IPV ranges from 10 to 69% among women internationally. Head, neck, or facial trauma is 7.5 times more likely in female patients presenting to the emergency department than female patients with other injury patterns. Forty-five percent of injuries acquired from IPV involve the eyes. IPV is the third leading cause of orbital fractures and traumatic ocular injuries from IPV tend to be severe in nature with a large percent of women sustaining scleral rupture.

SUMMARY

The high prevalence of IPV as a mechanism of orbital and ocular injury demands training all members of the ophthalmology team in identifying IPV, providing support, and making appropriate referrals to improve patient safety and well-being.

Analysis of radiographically confirmed blunt-mechanism facial fractures

Facial fractures resulting from blunt-mechanism trauma, although common, have been infrequently evaluated in large studies that do not include confirmation of fractures based on author review of available patient radiographic studies. An 8-year review (1998-2006) of the R Adams Cowley Shock Trauma Registry was performed with institutional review board approval. Patients diagnosed with blunt-mechanism facial fractures were identified by the International Classification of Diseases, Ninth Revision (ICD-9) codes and their facial fractures confirmed by author review of computed tomographic scans. Individual fractures were classified and grouped according to the facial thirds. Intra- and interreader variability was calculated, and confirmed fracture patterns were compared to fracture patterns listed by ICD-9 codes. Concomitant injuries and demographic data were additionally evaluated. Four thousand three hundred ninety-eight patients with 8127 fractures were identified. Intra- and interreader variability was 2% and 7%, respectively. ICD-9 coding misdiagnosed 12.5% of all fractures. Eighty-two percent of patients sustained associated injuries, including basilar skull fractures (7.6%) and cervical spine fractures (6.6%). 1.1% had at least one fracture in each facial third (panfacial fracture pattern). Significant relationships were found between demographic parameters, concomitant injuries, specific fractures, and fracture patterns. Studies investigating facial fractures should report fracture patterns confirmed by author review of available radiographic imaging. Large retrospective data sets containing confirmed fractures and capable of addressing rare fracture patterns can be compiled with low inter- and intrauser variability, and are useful for generating mechanistic hypotheses suitable for evaluation in prospective series or by directed biomechanical studies.

Evaluation of parameters in mixed male DNA profiles for the Identifiler® multiplex system

The analysis of complex DNA mixtures is challenging for forensic DNA testing. Accurate and sensitive methods for profiling these samples are urgently required. In this study, we developed 11 groups of mixed male DNA samples (n=297) with scientific validation of D‑value [>95% of D‑values ≤0.1 with average peak height (APH) of the active alleles ≤2,500 rfu]. A strong linear correlation was detected between the peak height (PH) and peak area (PA) in the curve fit using the least squares method (P<2e-16). The Kruskal-Wallis rank-sum test revealed significant differences in the heterozygote balance ratio (H(b)) at 16 short tandem repeat (STR) loci (P=0.0063) and 9 mixed gradients (P=0.02257). Locally weighted regression fitting of APH and Hb (inflection point at APH = 1,250 rfu) showed 92.74% of H(b) >0.6 with the APH ≥1,250. The variation of H(b) distribution in the different STR loci suggested the different forensic efficiencies of these loci. Allelic drop-out (ADO) correlated with the APH and mixed gradient. All ADOs had an APH of <1,000 rfu, and the number of ADO increased when the APH of mixed DNA profiles gradually decreased. These results strongly suggest that calibration parameters should be introduced to correct the deviation in the APH at each STR locus during the analysis of mixed DNA samples.

A Prospective Study of Strut versus Miniplate for Fractures of Mandibular Angle

This prospective randomized clinical trial compared the treatment outcomes of strut plate and Champy miniplate in fixation of mandibular angle fractures. Patients with mandibular angle fracture were consented and enrolled into this study. Exclusion criteria include patients with severely comminuted fractures. The patients were randomly assigned to receive the strut plate or Champy miniplate for angle fracture fixation. Patient demographics, fracture characteristics, operative and postoperative outcomes were collected prospectively. Statistical analysis was performed to evaluate the significance of the outcome. A total of 18 patients were included in this study and randomly assigned to receive either the strut plate or Champy miniplate. Out of which five patients were excluded postoperatively due to complex fracture resulting in postoperative maxillomandibular fixation. The final enrollment was 13 patients, N = 6 (strut) and N = 7 (Champy). There was no statistically significant difference in the pretreatment variables. Nine of these patients had other associated facial fractures, including parasymphyseal and subcondylar fractures. Most of the (11) patients had sufficient follow-up after surgery. Both groups exhibited successful clinical unions of the mandibular angle fractures. The complications associated with the mandibular angle were 20% in the strut plate group and 16.7% in the Champy group. One patient in the strut plate group had a parasymphyseal infection, requiring hardware removal. The strut plate demonstrated comparable surgical outcome as the Champy miniplate. It is a safe and effective alternative for management of mandibular angle fracture.

Violence and abuse: core competencies for identification and access to care

Violence and abuse (V/A) is recognized as a significant public health problem, especially in females. Injuries to the head, neck, and/or mouth are clearly visible to the dental team during examination. This article provides compelling evidence that supports the pivotal position occupied by oral health care professionals within the arena of detection, intervention, and prevention of V/A. This article reviews the epidemiology of orofacial risk factors for V/A, diagnostic tools and surveys for identifying victims of all ages, and suggests interdisciplinary educational curricula/specific algorithms to provide the necessary core competencies for identifying victims in the oral health care environment.

[Facial wounds: an epidemiological review of 850 cases]

BACKGROUND

Facial wound are among the most frequent emergencies. They often affect a young population. We studied the epidemiological profile of facial wounds admitted in our hospital.

PATIENTS AND METHODS

This prospective study was carried out in the Emergency Unit from June 2008 to June 2009. It included all patients having presented with at least one facial wound. The analysed parameters were patient, trauma, and wound characteristics.

RESULTS

Eight hundred and fifty patients were included, 20% of whom were female patients. The most frequent etiologies were traffic accidents for men, assault for women, and domestic accidents for children. Alcohol abuse was involved in 12.4% of the cases. The most frequent wound localization was frontal (35.4%). A craniofacial organ (eye, brain…) was affected in 6.1% of the cases; the wound was associated to a craniofacial fracture in 9.6% of the cases, and to an extrafacial lesion in 22% of the cases.

DISCUSSION

Facial wounds are a frequent emergency. They are predominant in young male patients. The high frequency of traffic accident and alcohol abuse requires an adequate prevention policy.

Orofacial injuries as markers for intimate partner violence

Health care professionals have increasingly recognized that intimate partner violence (IPV) is a highly prevalent public health problem with devastating effects on individuals, families, and communities. However, there are no obvious clinical characteristics of IPV. Interventions may prevent future IPV-related injuries, but they cannot be initiated until the diagnosis is made. Because of the frequency of IPV-related orofacial injuries, oral and maxillofacial surgeons (OMSs) may be the first and only health care providers to see these patients. Therefore, OMSs are in a pivotal position to diagnosis IPV-related injuries and expedite referral for interventional therapy. This article presents data that support the use of orofacial injuries as a prime predictor variable in identifying victims of IPV and provides: (1) an overview of the epidemiology of IPV-related orofacial injuries; (2) a discussion of the role of head, neck, and facial injuries as markers of IPV, and their role as a diagnostic tool to facilitate the early diagnosis and referral for management of IPV; (3) a list of the advantages and limitations of using orofacial injuries as indicators of IPV; and (4) future directions to improve efforts to educate OMSs in identifying patients who are at high risk for an IPV-related injury.

A 4-year retrospective study of facial fractures on Jeju, Korea

A number of researchers from various regions have reported statistical and clinical studies of facial fractures. The results of those studies show slight differences depending on regional, cultural, social and economic backgrounds. This report presents a statistical analysis of facial fractures occurring over 4 years on Jeju, Korea. The statistics come from the 318 patients who presented to Cheju National University Hospital for facial fractures, and ours is a retrospective study analyzing patient ages, gender, fracture etiology, alcohol involvement and the anatomical site of the fracture. The most common cause of facial fractures on Jeju was violence (40.9%), followed by traffic accidents (17%). The most frequently fractured site was the nasal bone (42.5%). According to the Jeju Statistics Agency, the people of Jeju are highly dependent on alcohol and previous research has reported the close relationship between alcohol consumption and violence. We paid close attention to violence as a primary cause for facial fractures in the cultural and social context of Jeju. Data analysis regarding facial fractures may provide crucial information for recognition of causes and planning for prevention.

Blunt assault is associated with failure of nonoperative management of the spleen independent of organ injury grade and despite lower overall injury severity

OBJECTIVE

Nonoperative management (NOM) of blunt splenic injuries has become standard of care for its high success rate. We observe that many blunt assault (BA) patients fail NOM despite lower overall injury severity. We performed this study to determine whether BA is independently associated with failed initial NOM (FiNOM) of splenic injuries.

METHODS

Using the Trauma Registry at our level I center, we reviewed data of all patients with blunt splenic injuries, who did not undergo immediate operative management of the spleen, admitted from January 1, 1992 to December 31, 2007. Initial NOM was defined as any patient who did not undergo immediate (< or =12 hours after admission) operative intervention for the spleen or did not undergo operation for the spleen at any time during the admission. FiNOM was defined as any patient who underwent operative management of the spleen greater than 12 hours after admission. Logistic regression was performed to determine whether BA was independently associated with FiNOM.

RESULTS

FiNOM occurred in 57 of the 419 (13.6%) patients initially managed nonoperatively. FiNOM decreased significantly in non-BA patients from 15.8% (1992-1999) to 6.2% (2005-2007) (p = 0.05) over time. This was not true for BA patients (33.3% vs. 30%) (p = 0.78). FiNOM for BA patients was 36.1% (13 of 36) versus 11.5% (44 of 383) for all other mechanisms combined. FiNOM was increased across all Organ Injury Scale scores for the spleen in BA patients. BA was independently associated with FiNOM.

CONCLUSIONS

BA is associated with FiNOM independent of severity of splenic injury. Despite an increasingly successful policy of NOM in all blunt splenic injuries, this does not apply for BA. BA should be an important factor considered when initial NOM is contemplated for blunt splenic injury because of the high failure rates compared with all other mechanisms.

A Protocol to Diagnose Intimate Partner Violence in the Emergency Department

BACKGROUND

To better identify women at risk for intimate partner violence (IPV), we developed a diagnostic protocol composed of injury location and response to a verbal questionnaire to identify women at high risk for reporting an IPV-related injury etiology. The purpose of this study was to test the external validity of the protocol when applied at two institutions that differ considerably in terms of geography and socioeconomic measures.

METHODS

A cross-sectional design was used at two demographically and geographically different hospitals, designated H1 and H2. The sample was composed of adult females age >or=18 years presenting to the emergency department (ED) for evaluation and management of nonverifiable traumatic injuries. The predictor variable was risk for reporting an IPV-related injury. Risk was categorized per the protocol as high or low. High-risk subjects had visible head, neck, or face (HNF) injuries and positive responses to the questionnaires. Low-risk subject had non-HNF injuries or negative responses to the screening questionnaires. The outcome variable was self-reported injury etiology classified as IPV-related or other. Descriptive and bivariate statistics and standard measurements for a diagnostic test were computed.

RESULTS

The sample was composed of 400 subjects, with 200 subjects enrolled at each institution. Self-reported IPV was 34% and 9.5% at H1 and H2, respectively. The protocol classified 33% (H1) and 18% (H2) of subjects as high risk. Sensitivities were 90% (H1) and 74% (H2). Specificities were 96% (H1) and 88% (H2). Subjects classified per protocol as high-risk had an 18-fold (p < 0.01, H1) and 13-fold (p < 0.01, H2) increased risk for reporting IPV-related injuries.

CONCLUSIONS

Despite significant geographic and socioeconomic differences between the two hospitals, the results suggest that our protocol may be applicable in disparate clinical settings.

Intimate partner violence and physical health consequences: policy and practice implications

Extensive research indicates that intimate partner violence (IPV) poses a significant risk to the physical health of women. IPV is associated with increased mortality, injury and disability, worse general health, chronic pain, substance abuse, reproductive disorders, and poorer pregnancy outcomes. IPV is also associated with an overuse of health services and unmet need for services, as well as strained relationships with providers. The body of IPV research has several critical gaps. There are almost no longitudinal studies of IPV and health. Most studies are clustered into a few specialties, with almost no research in the areas of allied health, dentistry, or management. A common definition of IPV is still not used. Finally, with some notable exceptions, there has been little success in moving the health care system to routinely screen women for IPV.