Beyond facial injury: prognostic utility of maxillofacial trauma scores in the emergency department

TL;DR

This study evaluates how well two maxillofacial trauma scores predict outcomes like ICU admission and death in adult trauma patients.

Contribution

The study demonstrates the prognostic value of FISS and MFISS scores in emergency risk stratification for multiple trauma patients.

Findings

Higher FISS scores correlate with intracranial injuries, ICU admission, and mortality.

FISS and MFISS scores show good predictive performance for mortality with AUCs of 0.820 and 0.758, respectively.

Abstract

To evaluate the prognostic utility of two widely used maxillofacial trauma scoring systems (MFTSs) -the Facial Injury Severity Score (FISS) and Maxillofacial Injury Severity Score (MFISS)- in adult multiple trauma patients in the emergency department (ED).

This prospective observational study was conducted in the ED of a tertiary care hospital between 01.08.2020 and 01.08.2021. A total of 124 MFT patients aged ≥ 18 years with at least one concomitant injury to another organ system were included. FISS and MFISS were calculated for each patient. The associations between scores and coexisting injuries, intensive care unit (ICU) admission, and mortality were analyzed. Predictive performance for mortality was assessed using receiver operating characteristic (ROC) curve analysis.

Higher FISS scores were significantly associated with intracranial injuries, including subarachnoid hemorrhage (SAH), cranial fractures, and pneumocephalus (all p < 0.01), as well as with pneumothorax, rib fractures, ICU admission, and mortality (all p ≤ 0.004). MFISS scores were significantly higher in patients with SAH, while a negative association was observed between MFISS and abdominal injuries (p = 0.043). ROC analysis demonstrated good predictive performance for mortality, with areas under the curve of 0.820 for FISS and 0.758 for MFISS (both p < 0.01).

FISS and MFISS are associated with clinically meaningful outcomes and may serve as practical tools for early risk stratification and prognostic assessment in the ED among adult multiple trauma patients with maxillofacial injuries.

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