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Pediatric facial fracture patterns in a Level 1 Trauma center

Lead Physician: Matthew Greives, MD

Pediatric facial fracture patterns in a Level 1 Trauma center: mechanisms, management, and outcomes

McGovern School of Medicine at the University of Texas Health Sciences Center at Houston and Children’s Memorial Hermann Hospital, Memorial Herman Texas Trauma Institute.

Background and Significance

While fractures of the facial skeleton can occur in any age group, their management differs when the patient is a child. Many more pediatric facial fractures can be managed non-operatively than is commonly practiced in the adult population 1 . Therefore, the diagnosis and management of these pediatric facial fractures is of special interest to providers of trauma care, to ensure that proper treatment is provided. Studies of larger trauma populations, both in their relative incidence and in their management, are therefore invaluable in providing this vital information.

The mechanism for these facial fractures in the pediatric population is different from adult populations. Sports and activity related injuries have been implicated as playing a more substantial role in the occurrence of pediatric facial fractures than in adult counterparts. 2, 3 However, violence is ubiquitous and a frequent cause of some of the more severe cases. 4, 5 Concurrent injuries of the cervical spine or traumatic brain injury are also commonly associated with the pediatric patients who are diagnosed with facial fractures. 3, 6 The presence of these or other injuries can complicate the management of the facial fractures themselves. A large sample of these patients would provide a thorough understanding of the relationship of these different mechanisms and the outcomes that the pediatric patients face.

While a few studies have looked at the relative frequency of facial fractures in the pediatric populations, 2 assessment of the difference in the population within our own trauma population have not been performed. We propose to analyze the relative incidence of pediatric facial fractures in the busiest trauma institute in the country, the Memorial Hermann Texas Trauma Institute to better understand the causes and treatments for these patients.

Purpose:

The purpose of this study is to examine pediatric (≤18yo) patients who presented to the Memorial Hermann Trauma Institute with a diagnosis of facial fractures.

Primary objective:

Assess the patterns and mechanism of pediatric patients who sustained a facial fracture.
Secondary Objective: Evaluate the rates of surgical vs. non-operative management for pediatric patients with facial fractures.

Investigational Plan:

This is a retrospective study involving the medical records of pediatric patients presented to the Memorial Herman Trauma Institute with the diagnosis of a fracture of one or more of their facial bones.

Inclusion Criteria:

  1. Patients ≤18 years of age 
  2. Patients diagnosed with one or more facial fractures

Exclusion Criteria:

  1. Patients over the age of 18.
  2. Patients with incomplete medical records

Procedure

This proposed study is a retrospective chart review and data collection of the past 10 years of the pediatric patients who presented to the Memorial Herman Texas Trauma Institute with the diagnosis of one or more facial fractures.

  1. From January 1 2006 -  December 31, 2015
  2. Data collection points will include
    1. Type of fracture
    2. Mechanism of trauma
    3. Associated brain or cervical spine involvement
    4. Surgical management vs. non-operative management
    5. Length of stay
  3. Electronic records from Memorial Hermann Hospital and Children’s Memorial Hermann Hospital, as well as any notes from the Memorial Hermann Texas Trauma Institute will be assessed.
  4. Patient list will be generated querying the Trauma registry using ICD 9 codes for facial fractures with the age parameter set at 18 years or younger.  
  5. The data will be collected by the principle investigator and study team.
  6. Data will be collected and stored on a password protected University of Texas computer located in the locked office of the PI.
  7. Patient Identifiers Collected will be contained to the linking log. These include: Name, Date of birth, dates of trauma, treatment, and medical record number.
  8. All patient data will be destroyed per UT HOOP policy after the data is analyzed.  

Sample Size:

We anticipate a sample size of 5000 patients who have been treated at the Memorial Hermann Texas Trauma Institute as pediatric patients with facial fractures over the past ten years. This is an estimate as we have not previously queried the database for a true number over the time period that we hope to analyze.

Data Analysis  

We proposed to analyze the data to get an assessment of the relative rates of different type of facial fracture patterns that affect our patient population.

Potential Benefits:

While no direct benefits will extend these patients, they will help determine the rates of facial fractures in our pediatric patient population. We will also be able to document the rates of surgical versus non-surgical management for each type of facial fracture. This will benefit the entire scientific community as well considering this information will be from the largest trauma center in the nation, and therefore likely to have the largest patient population to draw from.

Risks/Discomforts:

Patients included in this study will have no changes made to their treatment course. There will be no medical risk incurred by these patients. This poses no more than minimal risk as it is a retrospective chart review and the only risk is loss of patient confidentiality.  

Consent:

We are applying for a waiver of consent due to the retrospective chart review of these patients.

Confidentiality:

Research data will include any personal health information that can be used to identify the patients. Records will be kept on a password locked computer in the Principal Investigator’s locked office at all times. Release of information will only occur with de-identified data for research purposes. Patient information will only be accessible via the McGovern School of Medicine at the University of Texas Health Science Center at Houston’s encrypted file sharing program. This program will not allow the data to be downloaded, only viewed.

Cost/Payment:

There will be no direct cost to the patient/parent as part of this study. No additional costs are incurred by entering this study.

References :

  1. Allred LJ, Crantford JC, Reynolds MF, David LR: Analysis of Pediatric Maxillofacial Fractures Requiring Operative Treatment: Characteristics, Management, and Outcomes. J Craniofac Surg 2015, 26:2368-74.
  2. Grunwaldt L, Smith DM, Zuckerbraun NS, Naran S, Rottgers SA, Bykowski M, Kinsella C, Cray J, Vecchione L, Saladino RA, Losee JE: Pediatric facial fractures: demographics, injury patterns, and associated injuries in 772 consecutive patients. Plast Reconstr Surg 2011, 128:1263-71.
  3. Afrooz PN, Grunwaldt LJ, Zanoun RR, Grubbs RK, Saladino RA, Losee JE, Zuckerbraun NS: Pediatric facial fractures: occurrence of concussion and relation to fracture patterns. J Craniofac Surg 2012, 23:1270-3.
  4. Hoppe IC, Kordahi AM, Lee ES, Granick MS: Pediatric Facial Fractures: Interpersonal Violence as a Mechanism of Injury. J Craniofac Surg 2015, 26:1446-9.
  5. Hoppe IC, Kordahi AM, Paik AM, Lee ES, Granick MS: Pediatric facial fractures as a result of gunshot injuries: an examination of associated injuries and trends in management. J Craniofac Surg 2014, 25:400-5.
  6. Halsey JN, Hoppe IC, Marano AA, Kordahi AM, Lee ES, Granick MS: Characteristics of Cervical Spine Injury in Pediatric Patients With Facial Fractures. J Craniofac Surg 2016, 27:109-11.

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