PubMed · 9923366
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PURPOSE: This study evaluated the use of a single 30 degrees occipitomental radiograph as an effective screening procedure for midface fractures. PATIENTS AND METHODS: The emergency room 30 degrees occipitomental films of 105 consecutive patients with suspected midface fractures were examined independently by 2 oral and maxillofacial surgeons (OMFS). They were asked to identify whether a midfacial fracture existed in each case. They also identified those cases in which they believed a computed tomography (CT) scan was indicated for definitive diagnosis of midfacial fractures. These findings and recommendations were then compared with the actual diagnosis and imaging studies for these patients to determine the efficacy of a single occipitomental film, supplemented by CT scans when indicated, in identifying midface fractures. RESULTS: Of the 105 occipitomental films, one oral and maxillofacial surgeon recommended CT scans for 13 of the 105 patients, and the second recommended CT scans for 26 patients. Seventeen patients actually had had CT scanning performed, and a midface fracture was identified in 12 cases. Of these 12 patients, 8 were treated by surgical intervention. One OMFS identified 11 of the 12 fractures that were subsequently identified in the emergency room, including all of the 8 that required surgical treatment, whereas the second OMFS identified all 12 of the fractures seen in the emergency room. CONCLUSION: A single 30 degrees occipitomental radiograph, augmented with CT scans when indicated, can accurately identify all midface fracture requiring treatment. The current practice of obtaining a series of plain radiographs may be unnecessary.
OBJECTIVE: To determine how the influx of patients in an emergency room (ER) is spread over the week and what factors play a part. DESIGN: Prospective. METHOD: The ER contacts in the De Weezenlanden Hospital of Zwolle, the Netherlands, were recorded on standardized forms during the period 1 May-14 June 1997 (6 weeks). RESULTS: 1995 ER contacts were recorded: 47% were referred by the GP and 8% by the municipal ambulance service, while 45% came at their own initiative. Injuries to the locomotor apparatus and wounds accounted for at least 50% of all contacts and were more frequent among patients attending at their own initiative (73%) or delivered by the ambulance service (49%) than among those referred by the GP (31%). Patients with various diseases, on the other hand, were mostly referred by the GPs (62%). 76% of all contacts occurred between 8 a.m. and 8 p.m. There was no Friday afternoon peak. The differences between the number of contacts during the week and in the weekend were not significant. Of the patients referred by the GP or delivered by the ambulance service more than half were admitted to the hospital, as against 18% of the patients attending at their own initiative. CONCLUSION: In the ER examined there were not more new patients on the Friday afternoon than during the rest of the week.