479 - The use of radiographic imaging for suspected midface fractures in the Accident & Emergency Department

N Gallagher CJ Lloyd
Presented by: Nicola Gallagher
Glan Clwyd Hospital

Introduction - Facial injuries frequently present in A&E where it has become common practice to request radiographic imaging prior to specialist referral. Facial bone x-rays are frequently requested if a midface fracture is suspected but previous studies indicate that only 30% of requests are justified. In response to requests for plain film imaging it has become common practice to take at least two occipitomental views (OM, OM30). There are studies demonstrating that a single OM30 view is sufficient, although computed tomography (CT) is now the gold standard. This study investigates the use of radiographic imaging for suspected midface fractures. Methods - Data was retrospectively examined for a 10-week period for the requests of facial bone imaging for suspected midface fractures. Results - There were 76 requests for plain film imaging (69 adults, 7 children), midface fractures were reported for 6 (8%) patients (all adults). The number of images taken varied; with one, two, three and four views taken for 12 (16%), 54 (70%), 10 (13%) and 1 (1%) patient respectively. There were 53 requests for facial CT (51 adults, 2 children). Midface fractures were reported for 17 (32%) patients (16 adults, 1 child), 10 of which were isolated nasal bone fractures. A&E doctors requested 97% of images, only 4 (3%) patients had an OMFS review prior to imaging. Conclusion - Radiographic imaging for facial injuries is common. A positive finding of a midface fracture from plain film imaging is low (8%). This could suggest that some requests are unjustified and radiographic imaging is potentially overused. Midface fractures were detected in 32% of facial CT, however 59% (n=10) of these were isolated nasal bone fractures for which radiographic imaging is not advised. These results have highlighted a potential need for an improved clinical pathway for suspected midface injuries. The result is a collaborative project between OMFS, A+E and Radiology that will improve patient care.
Consent Statement: There are no details on individual patients reported within the abstract.

Poster