Tuesday’s breakfast

1. Tuesday’s breakfast Int. 林泰祺

3. Introduction • Maxillofacial injuries in isolation or in combination with other injuries account for a significant percentage of emergency room and hospital admissions • Several statistical models have been developed to predict the outcome of trauma patients • These scoring systems are either based on anatomic location of injuries, physiologic data, physical examination findings or a combination

4. Introduction • The Glasgow Coma Scale (GCS) and the Revised Trauma Score and Injury Severity Score (TRISS) are universally used for the evaluation of trauma and have proven to be predictive of Outcome • The Injury Severity Score (ISS) is an anatomic scoring system developed in 1974 that provides an overall score for patients with multiple injuries

5. Introduction • The New Injury Severity Score (NISS) and followed by the International Classification of Disease Ninth Revision-based Injury Severity Score (ICISS) • The Acute Physiologic and Chronic Health Evaluation (APACHE) score is more complex to determine on the initial evaluation of trauma

6. Introduction • The new Physiologic Trauma Score that combines the admission Systemic Inflammatory Response Syndrome (SIRS) score with the GCS and age has been found to be comparable to other models (TRISS, ISS, ICISS)

7. Introduction • Facial fractures occur in a variety of combinations that frequently require specific descriptions of individual fractures rather than application of a set classification system

8. Introduction • The Le Fort classification pattern • Le Fort I, II, and III patterns of facial facture • Does not encompass the mandible or the upper face • Bowerman classification system • Classification for the middle third of the face • Does not include fracture severity or treatment implications and has not gained wide acceptance

9. Materials and Methods • All patients admitted to the trauma service at Legacy Emanuel Hospital (Level I Trauma Center) in Portland, Oregon between January 1, 1993 and June 30, 2003 with facial fractures, with or without concomitant non-facial injuries, were identified retrospectively

10. Materials and Methods • The following data were collected; age, gender, mechanism of injury, detailed diagnosis of facial fractures, disposition, and the length of hospital stay (LOS). • The hospital operating room charges (ORC) for the treatment of each patient’s facial injuries was also obtained.

12. Results • A total of 1,115 patient admissions to Legacy Emanuel Hospital’s Emergency Department • Full information on operating room charges (ORC) was available for 247 patients (average age: 32, SD ± 17; range, 2 to 84; male:female, 3:1; blunt:penetrating, 232:15) • The FISS scores were calculated for each patient (average FISS: 4.4, SD ± 2.7; range 1 to 13) • Hospital operating room charges for the treatment of each patient’s maxillofacial injuries were obtained from the hospital financial services (average ORC: $4,135, SD ± $2,832; range, $845 to $18,974)

13. Results • A significant correlation was identified between the FISS and the ORC (R value .82) • The length of stay was significantly associated with the FISS. (t 4.7, 245 degrees of freedom, P .000004) • Although the association was statistically significant, FISS is not a very good predictor of length of stay. The correlation between the predicted and observed values was R .38. • There were 3 deaths among the 247 patients. Those 3 deaths had higher than average FISS scores, but the difference between the scores of survivors and non-survivors was not significant by a t test

15. Discussion • FISS is not designed primarily for use by the treating maxillofacial surgeon • FISS is applied to the patient by the consulting maxillofacial surgeon after adequate clinical and radiographic assessment • FISS can serve as a research tool for comparison and analysis of different groups of patients with facial injury

16. Discussion • Our data do not prove or disprove that a higher FISS score indicates a greater likelihood of a less favorable esthetic or functional outcomes • The FISS is not an indicator of treatment modality. It is a predictor of the severity of the injury as measured by cost, independent of the treatment modality used • It is based on a retrospective extrapolation of standard treatment of facial fractures at our institution as dictated by the 3 senior staff surgeons

17. Discussion • We hypothesize that the FISS would be a better predictor of LOS if we only considered patients with isolated maxillofacial injuries and controlled for discharge criteria that are independent of the maxillofacial injury • We hypothesize that the higher the FISS the greater the possibility of a negative outcome (death)

18. Discussion • The extent of soft tissue injury was more difficult to incorporate into the FISS • In our study the correlation of the FISS was increased by assigning one point to lacerations of over ten centimeters in combined length

19. Conclusion • Facial Injury Severity Scale (FISS) that is easily calculated and reliably predicts the severity of maxillofacial injuries as measured by the operating room charges required to treat the facial injury • The FISS is also an indicator of hospital length of stay • FISS is based on averages among a large sample of patients and each patient presents with a unique and individual set of injuries • The FISS may be a research tool for future studies involving maxillofacial injuries

20. Thank you!!