Characteristics of Facial Fractures in Critically Injured Children

Abstract

Background: Treatment of facial fractures in pediatric patients requiring intensive care unit (ICU) care has not been well categorized. The purpose of this study is to describe a single-institution experience with the management of pediatric facial fractures in patients requiring ICU-level care. Methods: We performed a retrospective review of patients under 18 years old who presented to a level I trauma center with facial fractures between 2006 and 2021. Types of facial fractures, mechanisms of injury, operative treatment, GCS score, and associated injuries were evaluated in ICU patients compared to patients who were admitted to the hospital, but not ICU. Results: Facial fractures were diagnosed in 3334 patients. Of them, 1080 were admitted to the hospital and 207 patients (19.2%) required ICU-level care. Among these patients, the average age was 9.7 ± 4.9 years. The average length of stay was 9.2 ± 10.9 days and the average lowest GCS score was 10.3 ± 4.6. The most common mechanism of injury was a motor vehicle accident (n = 122, 59.5%). Compared to non-ICU admitted patients, patients admitted to the ICU were significantly more likely to present with skull (n = 124, 60.5%, P < .001), orbital (n = 140, 68.3%, P < .001), and maxillary fractures (n = 96, 46.8%, P < .001) and significantly less likely to present with mandibular fractures (n = 47, 22.9%, P = .020). ICU patients had significantly more associated injuries, particularly neurological injuries (91.2% vs 47.8%, P < .001). ICU patients underwent operative treatment at the same rate as non-ICU admitted patients (OR, 0.7 [95% CI, 0.5-1.0]). Conclusions: Pediatric facial fracture patients requiring ICU-level care are a poorly characterized population. Our data suggest that high impact mechanisms of injury and specific fracture patterns are associated with ICU admission as these patients require particular attention and management.