T. Soleimani1, T. M. Bell2, Y. Tahiri1, R. Sood1, R. L. Flores1, N. Nosrati1, S. S. Tholpady1 1Indiana University School Of Medicine,Plastic Surgery,Indianapolis, IN, USA 2Indiana University School Of Medicine,Surgery,Indianapolis, IN, USA
Introduction:
Facial fractures in the pediatric population, although less common than in adults, have a significant impact on public health and the US economy. Although some demographic data exists regarding the overall epidemiology of facial fractures in adults and children, little attention has been paid to the patterns of facial fractures based on the etiology of the trauma. This study was designed to provide a more thorough analysis via a large dataset.
Methods:
The KID (Kid Inpatient Database) was used to analyze pediatric facial fractures. Data from years 2000-2009 was studied. 21,533 patients aged 0-17 were identified using ICD-9 diagnosis codes for facial fractures. National estimates of incidence and distribution of pediatric facial fracture by mechanism were obtained. Association of demographics with mortality and length of stay (LOS) as the outcomes of interest was assessed by bivariate analysis using SAS.
Results:
The incidence of facial fractures increased with age and 49% of patients were 15 to 17 years old. 70% of the patients were male. 59% of patients were white, 18% were African-American, and 15.6% were Hispanic. The most frequent primary payer was private insurance (54%) followed by Medicaid (25%). Most of the patients were admitted at large (68%), urban (94%), teaching (75%) hospitals. The top 4 trauma mechanisms were motor vehicle accident (MVA) (43%), intentional trauma (IT) (17%), falls (11%) and non-intentional trauma (NIT) (9%). Compared to other trauma mechanism groups, patients in the IT group were more likely to be older, male, African-American, low income, covered by Medicaid, and treated in northeastern hospitals. 47% of patients had concomitant injuries including skull fracture, intracranial injuries, and cervical spine injuries. The overall mortality rate was 2.0%. Mortality was highest in the MVA group (3.4%) followed by IT group (0.6%). Having concomitant injury was associated with a higher mortality. In MVA, IT, and NIT groups, younger age was associated with higher rate of concomitant injury. Compared to male patients, female patients were more likely to have concomitant injury and mortality in IT and NIT groups. They were less likely to have concomitant injury in MVA group. In all four groups, mortality rate decreased by age and longer LOS was associated with African-American race, Medicaid payer, and receiving treatment at urban, teaching, and public hospitals.
Conclusion:
This study shows that the epidemiology and pattern of pediatric facial fracture differs based on the etiology of the trauma. Increasing incidence of facial trauma by age suggests increased vulnerability of the face in older children and higher risk-taking behavior in this group. The analysis demonstrated young female victims have a greater risk of mortality and that LOS increases with African-American race. Because poor outcomes are more likely in vulnerable populations, further analysis of the causes of increased mortality and LOS is warranted.