• Romke Rozema, MoumniMostafa ElMEhttp://orcid.org/0000-0001-6186-7757Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands., Gysbert T de Vries, Frederik K L Spijkervet, René Verbeek, Jurrijn Y J Kleinbergen, BensBas W JBWJDepartment of Emergency Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands., DoffMichiel H JMHJhttp://orcid.org/0000-0002-2619-8903Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands.Department of Oral and Maxillofacial Surger, Baucke van Minnen, and REDUCTION study group.
• Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Hanzeplein 1, 9700 RB, Groningen, The Netherlands. r.rozema01@umcg.nl.
• Eur J Trauma Emerg Surg. 2022 Oct 1; 48 (5): 4243-4254.

PurposeTo assess physical examination findings related to maxillofacial trauma to identify patients at risk of midfacial and mandibular fractures and then to construct a clinical decision aid to rule out the presence of midfacial and mandibular fractures in emergency department patients.MethodsWe performed a prospective multicentre cohort study in four hospitals in the Netherlands, including consecutive patients with maxillofacial trauma. Each patient received a standardized physical examination consisting of 15 and 14 findings for midfacial and mandibular traumas, respectively. Consequently, clinical decision aids were constructed with the focus being on ruling out the presence of midfacial and mandibular fractures, and diagnostic accuracy was calculated.ResultsA total of 993 consecutive patients were identified of whom 766 and 280 patients were suspected of midfacial and mandibular fractures, respectively. Midfacial fractures were diagnosed in 339 patients (44.3%), whereas mandibular fractures were observed in 66 patients (23.6%). The decision aid for midfacial trauma consisting of peri-orbital hematoma, epistaxis, ocular movement limitation, infra-orbital nerve paresthesia, palpable step-off and tooth mobility or avulsion, produced a sensitivity of 89.7 (86.0-92.5), a specificity of 42.6 (38.0-47.4), and a negative predictive value of 83.9% (78.4-88.2). The decision aid for mandibular trauma consisting of the angular compression test, axial chin pressure test, objective malocclusion, tooth mobility or avulsion and the tongue blade bite test resulted in a sensitivity of 98.5 (91.9-99.7), a specificity of 34.6 (28.5-41.2), and a negative predictive value of 98.7% (92.8-99.8).ConclusionThe constructed clinical decision aids for maxillofacial trauma may aid in stratifying patients suspected for midfacial and mandibular fractures to reduce unnecessary diagnostic imaging.Clinical Trial RegistrationThe study was registered at ClinicalTrials.gov with the identifier NCT03314480.© 2022. The Author(s).

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