Transcript Tuesday’s breakfast

Tuesday’s breakfast
Int. 林泰祺
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
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
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
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)
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
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
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
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.
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)
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 nonsurvivors was not significant by a t test
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
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
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)
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
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
Thank you!!