Epidemiology of Animal-Related Facial Fractures in Pennsylvania
Joseph E. Cillo Jr., DMD, MPH, PhD*
Svitozar Fokshey, DDS, MD **
*Program Director
** Resident
Division of Oral and Maxillofacial Surgery
Allegheny General Hospital
West Penn Allegheny Hospital System
Pittsburgh, Pennsylvania
Statement of the Problem: There is a paucity of data on the incidence and prevalence of animal-related facial fractures in Pennsylvania. The objective of this study was to evaluate the incidence and prevalence animal-related facial fractures in Pennsylvania to aid in understanding etiology and development of prevention strategy.
Subjects and Methods: This was a cross-sectional analysis of secondary data obtained from the Pennsylvania Trauma Registry Database for subjects registered between 2000 and 2010 with animal–related facial trauma according to the ICD-9-CM codes E906.0 – 906.9 and 802.0 – 802.9. Data was collected for demographics, facial fractures, Glasgow Coma Scale (GCS), Injury Severity Scale (ISS), Trauma Revised Injury Severity Scale (TRISS), A Severity Characterization of Trauma (ASCOT), Abbreviated Injury Scale (AIS) for face, intubation rate, ventilator days, and ICU length of stay.
Statistical Analyses
Statistical analysis was conducted using the Excel statistical package. Standard descriptive statistics with mean, median, standard deviations, range, and percentages were used. The number of animal-related facial fractures per 100,000 residents per year evaluated for incidence and prevalence using data from the United States Census Bureau on the Pennsylvania population from 2000 to 2010.
Results
There were 303 total subjects included in this study with a mean age was 29.8 years (Median (Mdn) 25.0, Standard Deviation (SD) 21.3, Range (R) 1 – 79) and divided equally between 151 males (50%) and 152 females (50%). There were two primary mechanisms of injury which included 202 (67.7%) subjects butted, gored, fallen on, run over, or stepped on by an animal not being ridden and 101 (33.3%) subjects involved on an animal being ridden. There were 78 nasal bone fractures (25.7%), 134 mandible fractures (44.2%), 94 midface fractures (31.0%), 139 orbital fractures (33.9%) and 9 other unspecified facial fractures (3.0%). The mean for GCS was 13.2 (Mdn 15.0, SD 3.9, R 3.0 – 15.0), for ISS was 14.5 (Mdn 13.0, SD 9.2, R 1.0 – 43.0), for TRISS 0.9 (Mdn 1.0, SD 0.1, R 0.0 – 1.0), for ASCOT was 0.9 (Mdn 0.9, SD 1.0, R 0.2 – 1.0) and for AIS face was 1.8 (Mdn 2.0, SD 1.3, R 1.0 – 9.0). Twenty-one subjects (6.9%) required intubation. The mean ICU stay was 1.8 days (Mn 0, SD 4.5, R 0 – 42) with a mean ventilator day of 1.0 (Mdn 0.0, SD 3.7, R 0 – 41). Loss of consciousness occurred in 73 subjects (24.1%) and 151 subjects (49.8%) had concomitant skull fractures. age 0 - 42)9, range 3.0 - 15.1 rate wa (), midface fractures Animal-related facial fractures per 100,000 persons had an average incidence rate of 0.22 and a prevalence rate of 2.4.
Conclusions
The incidence and prevalence of animal-related facial fractures in Pennsylvania is low but resulted in a moderate amount of morbidity from facial and skull fractures. Primary prevention protocols should be developed for animal-related facial fractures that include face and head protection.
References
Zhang QB, Zhang B, Zhang ZQ, Chen Q. The epidemiology of cranio-facial injuries caused by animals in southern-central China. J Craniomaxillofac Surg. 40(6):506, 2012
Eckert V, Lockemann U, Püschel K, Meenen NM, Hessler C. Equestrian injuries caused by horse kicks: first results of a prospective multicenter study. Clin J Sport Med. 21(4):353, 2011.