Author(s)
Shannon Wu MD
Jeffrey Huynh BS
Noor Zanial BS
Cherian K. Kandathil MD
Sam Most MD MBA
Affiliation(s)
Stanford University School of Medicine, Division of Facial Plastic & Reconstructive Surgery, Palo Alto, CA, USA: Wu, Kandathil, Most
Stanford University School of Medicine, Palo Alto, CA, USA: Huynh, Zanial
Abstract:
Background: Nasal bone fractures (NBF) are the most common facial fractures and incur substantial healthcare costs. This study aimed to assess the utility of imaging in guiding surgical treatment for NBF.
Learning Objectives:
Investigate practice patterns of imaging in NBF across encounter settings.
Study Objective:
To assess the utility of imaging in guiding surgical treatment for NBF.
Design Type:
Retrospective cohort, single institution
Methods: This retrospective cohort study assessed patients with NBF between 2014-2024. Multivariable analyses assessed outcomes of imaging and surgery. National economic burden of additional imaging in NBF was calculated.
Results: Of 1,212 patients with suspected isolated NBF, etiologies were ground-level fall (43.3%), blunt injury (32.6%), assault (12.0%), and vehicle accidents (7.8%). Presentations were to Emergency Department (ED) (71.3%), facial plastic and reconstructive surgery (FPRS) (18.9%), and primary care (9.8%); imaging rates were 89.5%, 34.9%, and 66.4%, respectively (p<0.001). Surgery rates were 15.6% after CT, 14.7% after X-ray, and 37.1% after clinical diagnoses. Older age, non-blunt injury, and ED or PCP presentations were associated with imaging. Younger age, male sex, and presentation to FPRS were associated with surgery. The economic impact of imaging isolated NBF was $1.01 billion in hospital charges for imaging and $59 million in opportunity costs of ED waiting time.
Conclusion: Patients with suspected isolated NBF had high rates of imaging, which was inversely associated with surgery. Physical exam and history alone may reduce excess healthcare resource utilization of imaging for isolated NBF.