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Traumatic intracranial hemorrhages in facial fracture patients: review of 2,195 patients

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Abstract

Objective

Patients sustaining facial fractures are at risk for accompanying traumatic intracranial hematomas, which are a major cause of morbidity and mortality. Prompt recognition is crucial in improving patient survival and recovery. This study examined which simple clinical signs identify facial fracture patients at risk for intracranial hemorrhage before the performance of computed tomography.

Design and methods

Retrospective study of 2,195 patients with facial fractures during a period of 7 years. By means of univariate and multivariate analysis clinical features potentially predictive for (a) intracranial hemorrhage and (b) surgery for intracranial hemorrhage were identified.

Setting

Critical care units of anesthesiology and neurology, general traumatology, and oral and maxillofacial surgery in a level I trauma university hospital.

Results

Seizures (OR 22.1) and vomiting/nausea (OR 20.2) were the strongest independent predictors of intracranial bleeding in facial fracture patients. For intracranial hemorrhages requiring surgical intervention closed head injuries (OR 9.75) and cranial vault fractures (OR 5.0) were the most significant risk factors. However, among those patients without vomiting/nausea and without seizures and without closed head injury (n=1,628), 20 patients (1.2%) suffered intracranial hemorrhage, and six (0.37%) of them required surgical intervention.

Conclusions

Simple clinical symptoms, such as seizures, vomiting/nausea, history of a closed head injury or cranial vault fractures are strong predictors for intracranial hemorrhage in facial fracture patients. The early consideration of such important indicators allows us to detect patients at elevated risk of an intracranial hematoma requiring surgical intervention.

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Author information

Authors and Affiliations

  1. Department of Anesthesiology and Critical Care Medicine, University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria

    Matthias Hohlrieder & Arnulf Benzer

  2. Intensive Care Unit, Department of Neurology, University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria

    Josef Hinterhoelzl, Christiane Lang, Andreas Kampfl & Erich Schmutzhard

  3. Department of Biostatistics, University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria

    Hanno Ulmer

  4. Department of Traumatology, University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria

    Wolfgang Hackl

  5. Department of Oral and Maxillofacial Surgery, University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria

    Robert Gassner

  6. Department of Oral and Maxillofacial Surgery, University of Pittsburgh, 3501 Terrace Street, Pittsburgh, PA, 15261, USA

    Robert Gassner

Authors
  1. Matthias Hohlrieder
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  2. Josef Hinterhoelzl
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  3. Hanno Ulmer
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  4. Christiane Lang
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  5. Wolfgang Hackl
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  6. Andreas Kampfl
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  7. Arnulf Benzer
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  8. Erich Schmutzhard
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  9. Robert Gassner
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Correspondence to Matthias Hohlrieder.

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Hohlrieder, M., Hinterhoelzl, J., Ulmer, H. et al. Traumatic intracranial hemorrhages in facial fracture patients: review of 2,195 patients. Intensive Care Med 29, 1095–1100 (2003). https://doi.org/10.1007/s00134-003-1804-1

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  • DOI: https://doi.org/10.1007/s00134-003-1804-1

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