The Use of Safety Devices affects Facial Fracture Patterns ...



The Use of Safety Devices affects Facial Fracture Patterns in Motor Vehicle Collisions (MVC): Analysis of the National Trauma Database

D. Heath Stacey, MD, John Doyle, DDS, and Karol A. Gutowski, MD

INTRODUCTION: The National Highway Traffic Safety Administration reported that there were 39,189 fatalities in passenger vehicle collisions in 20051. Restraint devices were used in 53.2% of collisions resulting in occupant fatality versus restraint use in 85.6% of non-fatal collisions. Previous studies have shown that the use of restraint devices in vehicles does decrease the chance of sustaining a facial fracture2-5. There is debate over whether the use of a seatbelt with an airbag provides any extra benefit in preventing facial fractures, and whether the severity of facial trauma is effected by the use of seatbelt alone, seatbelt plus airbag, or airbag alone. Other studies have found no benefit in the use of restraint devices for preventing certain types of facial trauma6, 7.

This study was done to answer the following questions: 1.) What effect does the use of airbags and seatbelts have on facial fracture patterns? 2.) Does the use of safety devices effect the number of facial fractures sustained (1 or 2 vs. pan-facial)? 3.) Does the use of safety devices affect the incidence of facial lacerations? 4.) Are differences in facial fracture / laceration patterns seen in drivers versus passengers and can this be linked to safety device use? 5.) Does the clinical presentation of the 1 or 2 fracture group differ from the pan-facial group in this study population?

METHODS: A retrospective analysis was performed using the National Trauma Database (NTDB) from the 2000-2004, examining 272,856 patients who sustained trauma from a MVC. Patients who had missing data on diagnosis or fracture patterns were excluded. Only drivers and passengers of vehicles who either had a seatbelt, seatbelt plus airbag, airbag alone, or no restraint device were included in this study. The database was queried for accidents with facial fractures and facial lacerations. ICD-9 codes for facial fractures (mandible-802.20 to 802.39, malar/maxillary-802.4 to 802.5, and orbital floor-802.6 to 802.7) and for facial lacerations (870.1 to 870.9, 871.1 to 872.9, 872.1 to 872.9, 873.1 to 873.9, 874.1 to 874.9) were used to identify patients who sustained facial trauma. Nasal, naso-orbital-ethmoid, and frontal sinus fractures were excluded from this analysis due to difficulty in extracting these specific codes from the database. For analysis of severity of facial trauma and restraint device use, we identified “pan-facial” fracture patients as those diagnosed with a mandible fracture and malar / maxillary fracture and orbital fracture. Comparisons were then made between the group of 1 or 2 fracture diagnoses and the pan-facial fracture group.

Statistical analysis was performed comparing nominal variables using Chi-squared test of association. Fisher’s exact test was performed in order to obtain odds ratios and confidence intervals. A p value < 0.05 was considered to be statistically significant.

RESULTS: A total of 114,623 patients sustained facial lacerations and 15,293 patients sustained either a mandible, malar / maxillary, or orbital floor fracture. In all MVC victims, a seatbelt alone was used in 40.8%, an airbag alone in 4.2%, a seatbelt and airbag in 10.3%, and no restraint device in 44.7%. The use of a safety device was associated with decreased facial lacerations (OR 1.95), facial fractures (OR 2.26) (Figure 1), and pan-facial fractures (OR 2.98). This difference was accounted for by the use of seatbelts and seatbelts plus airbags. In the airbag only comparisons, there was no difference in facial trauma incidence in all three comparisons. Additionally, passengers with facial fractures were more likely than drivers to have not used any safety device (OR 1.65).

The pan-facial fracture group was compared to the 1 or 2 facial fracture group and these results are summarized in Figure 2.

CONCLUSIONS: The overall use of safety devices in patients involved in MVC who sustained facial trauma was low (50% of both groups.

REFERENCES:

1. National Highway Traffic Safety Administration. , Ed.

2. McGwin, G.,Jr, Metzger, J., Alonso, J. E., et al. The association between occupant restraint systems and risk of injury in frontal motor vehicle collisions. J. Trauma 54: 1182-1187, 2003.

3. Mouzakes, J., Koltai, P. J., Kuhar, S., et al. The impact of airbags and seat belts on the incidence and severity of maxillofacial injuries in automobile accidents in new york state. Arch. Otolaryngol. Head. Neck. Surg. 127: 1189-1193, 2001.

4. Murphy, R. X.,Jr, Birmingham, K. L., Okunski, W. J., et al. The influence of airbag and restraining devices on the patterns of facial trauma in motor vehicle collisions. Plast. Reconstr. Surg. 105: 516-520, 2000.

5. Simoni, P., Ostendorf, R., Cox, A. J.,3rd. Effect of air bags and restraining devices on the pattern of facial fractures in motor vehicle crashes. Arch. Facial Plast. Surg. 5: 113-115, 2003.

6. Yokoyama, T., Motozawa, Y., Sasaki, T., et al. A retrospective analysis of oral and maxillofacial injuries in motor vehicle accidents. J. Oral Maxillofac. Surg. 64: 1731-1735, 2006.

7. Cox, D., Vincent, D. G., McGwin, G., et al. Effect of restraint systems on maxillofacial injury in frontal motor vehicle collisions. J. Oral Maxillofac. Surg. 62: 571-575, 2004.

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OR = 2.26

CI=2.18-2.35

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