TY - JOUR T1 - Clinical and radiographic predictors of the need for facial CT in pediatric blunt trauma: a multi-institutional study JF - Trauma Surgery & Acute Care Open JO - Trauma Surg Acute Care Open DO - 10.1136/tsaco-2022-000899 VL - 7 IS - 1 SP - e000899 AU - Brittany N Nguyen AU - Mary J Edwards AU - Shachi Srivatsa AU - Derek Wakeman AU - Thais Calderon AU - Abdularouf Lamoshi AU - Kim Wallenstein AU - Tiffany Fabiano AU - Brittany Cantor AU - Kathryn Bass AU - Ananth Narayan AU - Ralph Zohn AU - Mitchell Chess AU - Richard D Thomas Y1 - 2022/04/01 UR - http://tsaco.bmj.com/content/7/1/e000899.abstract N2 - Background Facial injuries are common in children with blunt trauma. Most are soft tissue lacerations and dental injuries readily apparent on clinical examination. Fractures requiring operative intervention are rare. Guidelines for utilization of maxillofacial CT in children are lacking. We hypothesized that head CT is a useful screening tool to identify children requiring dedicated facial CT.Methods We conducted a multicenter retrospective review of children aged 18 years and under with blunt facial injury who underwent both CT of the face and head from 2014 through 2018 at five pediatric trauma centers. Penetrating injuries and animal bites were excluded. Imaging and physical examination findings as well as interventions for facial fracture were reviewed. Clinically significant fractures were those requiring an intervention during hospital stay or within 30 days of injury.Results 322 children with facial fractures were identified. Head CT was able to identify a facial fracture in 89% (287 of 322) of children with facial fractures seen on dedicated facial CT. Minimally displaced nasal fractures, mandibular fractures, and dental injuries were the most common facial fractures not identified on head CT. Only 2% of the cohort (7 of 322) had facial injuries missed on head CT and required an intervention. All seven had mandibular or alveolar plate injuries with findings on physical examination suggestive of injury.Discussion In pediatric blunt trauma, head CT is an excellent screening tool for facial fracture. In the absence of clinical evidence of a mandibular or dental injury, a normal head CT will usually exclude a clinically significant facial fracture.Level of evidence III.Data are available upon reasonable request. Data were obtained by retrospective chart review and a query of prospectively collected trauma databases from five centers in upstate New York. Data are available by request and can be shared after institutional authorization is obtained. ER -