Novel classification system could improve management of facial trauma

Sep 17 2012

By Sarah Guy, medwireNews Reporter

A novel scoring system based on the "best" elements of four existing systems can successfully differentiate injuries of patients with complex facial fractures, improving discrimination between severe injuries, report UK researchers.

The ZS Score considers all facial skeletal bones in sequence, and assigns higher weights to more severe fractures, compared with the other scoring systems, they add, in the British Journal of Oral and Maxillofacial Surgery.

"We have heavily weighted comminution of the fracture as a multiplier of the initial score, which produces appropriately higher regional scores as this influences technical difficulty and ultimate prognosis," explain the authors, who also include damage to teeth in the ZS Score.

Simon Holmes (Royal London Hospital, UK) and colleagues say that there is a genuine need for an injury severity score for maxillofacial trauma, which should be "quick and easy to use, encompass universal comprehension between different grades of staff, communicate severity, and provide guidance for treatment."

The four existing models reviewed included the Facial Injury Severity Score (FISS), which does not weigh all fractures equally and does not classify the mandibular angle, parasymphysis, orbital floor, or medical wall and rim, note the researchers.

However, the team incorporated FISS's inclusion of the frontal bone and dentoalveolar component of the mandible, as well as a soft tissue variable.

The team also included physiologic variables such as blood loss, from the Maxillofacial Injury Severity Score, as well as the Facial Fracture Severity Score's color-coded facial skeletal map, which "is the most intuitive and easy to use."

Finally, while Cooter and David's scoring system was the only one to include all facial bones and basilar trauma, it compressed regional scores "artificially" and underscored some of the 119 trauma patients whose January to November 2010 data Holmes and team considered in their study.

Overall, the ZS model positively correlated with all the other models, and the intraclass coefficients assessing inter- and intra-observer reliability were very high, at 0.98 and 0.99, respectively, report the researchers.

"We are certain that if all the four trauma scales had assigned higher weights to more severe fractures, all would have successfully scored trauma in the same manner as the ZS Score, with which we successfully differentiated between all trauma cases by increasing the width of the scale in the X-axis," concludes the team.

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