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A Case-Control Study of Traumatic Brain Injury and Facial Fractures

Heather T. Keenan, MD; Susan I. Brundage, MD; Diane C. Thompson, MS; Ronald V. Maier, MD; Frederick P. Rivara, MD, MPH

Arch Surg. 1999;134:14-17.

Background  The relationship between facial fractures and traumatic brain injury is controversial. Some studies show an increased risk of brain injury with the presence of facial fractures while others claim that facial fractures protect against brain injury.

Objective  To examine the association between facial fractures and traumatic brain injuries.

Design  Case-control study.

Setting  Subjects were recruited from the emergency departments of 7 hospitals in the Seattle, Wash, area.

Patients  Three thousand eight hundred forty-nine injured bicyclists and 5 scene deaths were identified from March 1, 1992, to August 31, 1994, with complete data available on 3388 bicyclists.

Interventions  None.

Results  The study group was composed of 1602 cases with injuries to the head, face, or brain and 1540 control subjects. There were 203 bicyclists with traumatic brain injuries, of whom 62 had an identifiable intracranial injury and 141 suffered a concussion. A total of 81 patients sustained facial fractures. The odds ratio for the risk of intracranial injury associated with facial fractures after adjustment for significant confounders was 9.9 (95% confidence interval, 5.1-19.3). The effect was less strong but still present when all traumatic brain injuries including concussions were considered (odds ratio, 2; 95% confidence interval, 1.1-3.7). No association was found for concussion only.

Conclusions  This study demonstrates no evidence that facial fractures help prevent traumatic brain injury. Data indicate that facial fractures are markers for increased risk of brain injury.

From the Department of Pediatrics, University of North Carolina, Chapel Hill (Dr Keenan); Department of Surgery, Harborview Medical Center (Drs Brundage and Maier), Department of Pediatrics and Epidemiology (Dr Rivara), and the Harborview Injury Prevention and Research Center (Ms Thompson and Dr Rivara), University of Washington, Seattle.