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NESPS 27th Annual Meeting Abstracts

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Impact of Increasing Compliance with Restraint Devices on Facial Fractures and Fiscal Implications for Plastic Surgeons
Joshua M. Adkinson, MD, Robert X. Murphy, Jr., MD, MS.
Lehigh Valley Health Network, Allentown, PA, USA.

Background: In 2009, the National Highway Traffic Safety Administration (NHTSA) projected that 33,963 people would die and millions would be injured in motor vehicle collisions (MVC). The estimated economic loss in Pennsylvania alone has risen from $12.3 billion in 1999 to $15.4 billion in 2008. Over the last two decades, legislative mandates and industrial initiatives have advanced the use of restraining devices in automobiles. Studies have shown that morbidity and mortality risks are decreased with use of restraining devices. NHTSA confirms that U.S. seat belt usage rates have steadily increased since 1994. This study evaluates longitudinal changes in facial fractures after MVC as a result of utilization of restraint devices.
Methods: We assessed MVC data from the Pennsylvania Trauma Systems Foundation-Pennsylvania Trauma Outcome Study from 1989-2009. Criteria for inclusion in database are diagnosis of trauma as well as: admission to ICU, admission to step-down unit, admission >48 hours, death, or transfer to trauma center. The database was queried for all MVC, facial fractures as identified by ICD-9 codes (802, 802.1, 802.29, 802.39, 802.4, 802.5, 802.6, 802.7), and patient restraint device use. Plastic surgeon cost data were extrapolated using the institution practice group database. Analysis was performed using Stata SE v 10.1 (StataCorp LP, College Station, TX).
Results: The database consisted of 135,773 individuals who met criteria with 15,335 sustaining at least one facial fracture over the study period (male, 65.6%; white, 87.2%; driver, 72.4%). MVCs with facial fractures in which no restraint was used fell from 75.6% in 1989 to 48.1% in 2009. While use of seat belts remained static (range 21.6-27.2%), air bag deployment increased from 0% at the beginning of the study to 15% by 2009. The combination of air bags and seat belts increased from 0% to 13.2% by 2009 (Table 1). Facial fractures are approximately 46% less likely to occur if any restraint is used compared to all other MVCs resulting in hospitalization (OR=0.54, 95% CI: 0.52-0.56). Sixty-three percent of facial fracture patients (n=9,731) had only 1 fracture, 21% (n=3,291) had 2, and 16% (n=2,313) had ≥3. Patients were 2.1% less likely every year to have ≥1 facial fracture in an accident (OR=0.979; CI: 974-0.984). Additionally, by 2009, multiple facial fractures were 30% less likely to be observed than in 1989 (OR=0.70; 95% CI: 0.56-0.88). Open nasal bone fractures, open/closed malar and maxillary fractures, and open orbital floor fractures tended to decrease over the study period, while closed orbital floor fractures increased.
Conclusions: Use of protective devices is increasing among patients involved in MVCs. This resulted in a change in incidence of different facial fractures with reduced need for reconstructive surgery. However, with such low utilization of the optimal combination of air bags and seat belts, a significant opportunity remains for improved vehicular patient safety and cost savings with increased utilization of appropriate restraining devices.
Table 1. Longitudinal Demographic Data
YearReported crashesPatients (% of study population)Facial fracture (%)Seat belt use (%)Air bag (%)Seat belt & Air bag (%)
1989151,4616358 (4.7)777 (5.1)162 (23.1)0 (0)0 (0)
1990141,3406190 (4.6)771 (5.0)156 (22.3)0 (0)0 (0)
1991130,4046189 (4.6)807 (5.3)166 (22.6)2 (0.3)0 (0)
1992133,9135947 (4.4)779 (5.1)196 (27.2)2 (0.3)0 (0)
1993134,3155645 (4.2)700 (4.6)155 (24.3)4 (0.6)6 (0.9)
1994134,1715870 (4.3)681 (4.4)185 (29.4)7 (1.1)9 (1.4)
1995136,8046167 (4.5)745 (4.9)172 (24.4)9 (1.3)12 (1.7)
1996142,8675795 (4.3)751 (4.9)162 (23.2)9 (1.3)14 (2.0)
1997143,9816124 (4.5)821 (5.4)171 (22.3)28 (3.7)20 (2.6)
1998140,9725682 (4.2)648 (4.2)150 (25.0)26 (4.3)22 (3.7)
1999144,1716328 (4.7)712 (4.6)142 (21.6)31 (4.7)24 (3.7)
2000147,2536514 (4.8)675 (4.4)148 (23.8)21 (3.4)25 (4.0)
2001131,3586582 (4.9)691 (4.5)161 (25.9)43 (6.9)17 (2.7)
2002138,1157547 (5.6)779 (5.1)176 (25.0)57 (8.1)26 (3.7)
2003140,1977082 (5.2)695 (4.5)161 (25.2)40 (6.3)39 (6.1)
2004137,4107019 (5.2)702 (4.6)170 (27.4)49 (7.9)39 (6.3)
2005132,8407296 (5.4)790 (5.2)168 (23.8)63 (8.9)51 (7.2)
2006128,3427457 (5.5)751 (4.9)144 (21.9)72 (10.9)54 (8.2)
2007130,6757364 (5.4)755 (4.9)162 (24.0)79 (11.7)69 (10.2)
2008125,3276697 (4.9)737 (4.8)152 (23.1)97 (14.8)74 (11.3)
2009Not available5920 (4.4)568 (3.7)116 (22.9)76 (15.0)67 (13.2)
TotalNA135,773 (100)15,335 (100)3375 (24.2)715 (5.1)568 (4.1)


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