Management of maxillofacial injuries with severe oronasal hemorrhage: a multicenter perspective.

Thomas H. Cogbill, Clay C. Cothren, Meghan K. Ahearn, Daniel C. Cullinane, Krista L. Kaups, Thomas M. Scalea, Lindsay Maggio, Karen J. Brasel, Paul B. Harrison, Nirav Y. Patel, Ernest E. Moore, Gregory J. Jurkovich, Steven E. Ross

Research output: Contribution to journalArticle

Abstract

BACKGROUND: Airway establishment and hemorrhage control may be difficult to achieve in patients with massive oronasal bleeding from maxillofacial injuries. This study was formulated to develop effective algorithms for managing these challenging injuries. METHODS: Trauma registries from nine trauma centers were queried over a 7-year period for injuries with abbreviated injury scale face >/= 3 and transfusion of >/=3 units of blood within 24 hours. Patients in whom no significant bleeding was attributed to maxillofacial trauma were excluded. Patient demographics, injury severity measures, airway management, hemostatic procedures, and outcome were analyzed. RESULTS: Ninety patients were identified. Median injury severity scores for 60 blunt trauma patients was 34 versus 17 for 30 patients with penetrating wounds (p <0.05). Initial airway management was by endotracheal intubation in 72 (80%) patients. Emergent cricothyrotomy and tracheostomy were necessary in 7 (8%) and 5 (6%) patients, respectively. Seventeen (57%) patients with penetrating wounds were taken directly to the operating room for airway control and initial efforts at hemostasis versus 12 (20%) patients with blunt trauma (p <0.05). Anterior or posterior or both packing alone controlled bleeding in only 29% of patients in whom it was used. Transarterial embolization (TAE) was used in 12 (40%) patients with penetrating injuries and 20 (33%) patients with blunt trauma. TAE was successful for definitive control of hemorrhage in 87.5% of patients. Overall mortality rate was 24.4%, with 6 (7%) deaths directly attributable to maxillofacial injuries. CONCLUSIONS: Initial airway control was achieved by endotracheal intubation in most patients. Patients with penetrating wounds were more frequently taken directly to the operating room for airway management and initial efforts at hemostasis. Patients with blunt trauma were much more likely to have associated injuries which affected treatment priorities. TAE was highly successful in controlling hemorrhage.

Original languageEnglish (US)
Pages (from-to)994-999
Number of pages6
JournalThe Journal of trauma
Volume65
Issue number5
StatePublished - Nov 2008
Externally publishedYes

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Maxillofacial Injuries
Hemorrhage
Wounds and Injuries
Airway Management
Penetrating Wounds
Intratracheal Intubation
Operating Rooms
Hemostasis
Abbreviated Injury Scale

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Cogbill, T. H., Cothren, C. C., Ahearn, M. K., Cullinane, D. C., Kaups, K. L., Scalea, T. M., ... Ross, S. E. (2008). Management of maxillofacial injuries with severe oronasal hemorrhage: a multicenter perspective. The Journal of trauma, 65(5), 994-999.

Management of maxillofacial injuries with severe oronasal hemorrhage : a multicenter perspective. / Cogbill, Thomas H.; Cothren, Clay C.; Ahearn, Meghan K.; Cullinane, Daniel C.; Kaups, Krista L.; Scalea, Thomas M.; Maggio, Lindsay; Brasel, Karen J.; Harrison, Paul B.; Patel, Nirav Y.; Moore, Ernest E.; Jurkovich, Gregory J.; Ross, Steven E.

In: The Journal of trauma, Vol. 65, No. 5, 11.2008, p. 994-999.

Research output: Contribution to journalArticle

Cogbill, TH, Cothren, CC, Ahearn, MK, Cullinane, DC, Kaups, KL, Scalea, TM, Maggio, L, Brasel, KJ, Harrison, PB, Patel, NY, Moore, EE, Jurkovich, GJ & Ross, SE 2008, 'Management of maxillofacial injuries with severe oronasal hemorrhage: a multicenter perspective.', The Journal of trauma, vol. 65, no. 5, pp. 994-999.
Cogbill TH, Cothren CC, Ahearn MK, Cullinane DC, Kaups KL, Scalea TM et al. Management of maxillofacial injuries with severe oronasal hemorrhage: a multicenter perspective. The Journal of trauma. 2008 Nov;65(5):994-999.
Cogbill, Thomas H. ; Cothren, Clay C. ; Ahearn, Meghan K. ; Cullinane, Daniel C. ; Kaups, Krista L. ; Scalea, Thomas M. ; Maggio, Lindsay ; Brasel, Karen J. ; Harrison, Paul B. ; Patel, Nirav Y. ; Moore, Ernest E. ; Jurkovich, Gregory J. ; Ross, Steven E. / Management of maxillofacial injuries with severe oronasal hemorrhage : a multicenter perspective. In: The Journal of trauma. 2008 ; Vol. 65, No. 5. pp. 994-999.
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abstract = "BACKGROUND: Airway establishment and hemorrhage control may be difficult to achieve in patients with massive oronasal bleeding from maxillofacial injuries. This study was formulated to develop effective algorithms for managing these challenging injuries. METHODS: Trauma registries from nine trauma centers were queried over a 7-year period for injuries with abbreviated injury scale face >/= 3 and transfusion of >/=3 units of blood within 24 hours. Patients in whom no significant bleeding was attributed to maxillofacial trauma were excluded. Patient demographics, injury severity measures, airway management, hemostatic procedures, and outcome were analyzed. RESULTS: Ninety patients were identified. Median injury severity scores for 60 blunt trauma patients was 34 versus 17 for 30 patients with penetrating wounds (p <0.05). Initial airway management was by endotracheal intubation in 72 (80{\%}) patients. Emergent cricothyrotomy and tracheostomy were necessary in 7 (8{\%}) and 5 (6{\%}) patients, respectively. Seventeen (57{\%}) patients with penetrating wounds were taken directly to the operating room for airway control and initial efforts at hemostasis versus 12 (20{\%}) patients with blunt trauma (p <0.05). Anterior or posterior or both packing alone controlled bleeding in only 29{\%} of patients in whom it was used. Transarterial embolization (TAE) was used in 12 (40{\%}) patients with penetrating injuries and 20 (33{\%}) patients with blunt trauma. TAE was successful for definitive control of hemorrhage in 87.5{\%} of patients. Overall mortality rate was 24.4{\%}, with 6 (7{\%}) deaths directly attributable to maxillofacial injuries. CONCLUSIONS: Initial airway control was achieved by endotracheal intubation in most patients. Patients with penetrating wounds were more frequently taken directly to the operating room for airway management and initial efforts at hemostasis. Patients with blunt trauma were much more likely to have associated injuries which affected treatment priorities. TAE was highly successful in controlling hemorrhage.",
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AU - Cogbill, Thomas H.

AU - Cothren, Clay C.

AU - Ahearn, Meghan K.

AU - Cullinane, Daniel C.

AU - Kaups, Krista L.

AU - Scalea, Thomas M.

AU - Maggio, Lindsay

AU - Brasel, Karen J.

AU - Harrison, Paul B.

AU - Patel, Nirav Y.

AU - Moore, Ernest E.

AU - Jurkovich, Gregory J.

AU - Ross, Steven E.

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N2 - BACKGROUND: Airway establishment and hemorrhage control may be difficult to achieve in patients with massive oronasal bleeding from maxillofacial injuries. This study was formulated to develop effective algorithms for managing these challenging injuries. METHODS: Trauma registries from nine trauma centers were queried over a 7-year period for injuries with abbreviated injury scale face >/= 3 and transfusion of >/=3 units of blood within 24 hours. Patients in whom no significant bleeding was attributed to maxillofacial trauma were excluded. Patient demographics, injury severity measures, airway management, hemostatic procedures, and outcome were analyzed. RESULTS: Ninety patients were identified. Median injury severity scores for 60 blunt trauma patients was 34 versus 17 for 30 patients with penetrating wounds (p <0.05). Initial airway management was by endotracheal intubation in 72 (80%) patients. Emergent cricothyrotomy and tracheostomy were necessary in 7 (8%) and 5 (6%) patients, respectively. Seventeen (57%) patients with penetrating wounds were taken directly to the operating room for airway control and initial efforts at hemostasis versus 12 (20%) patients with blunt trauma (p <0.05). Anterior or posterior or both packing alone controlled bleeding in only 29% of patients in whom it was used. Transarterial embolization (TAE) was used in 12 (40%) patients with penetrating injuries and 20 (33%) patients with blunt trauma. TAE was successful for definitive control of hemorrhage in 87.5% of patients. Overall mortality rate was 24.4%, with 6 (7%) deaths directly attributable to maxillofacial injuries. CONCLUSIONS: Initial airway control was achieved by endotracheal intubation in most patients. Patients with penetrating wounds were more frequently taken directly to the operating room for airway management and initial efforts at hemostasis. Patients with blunt trauma were much more likely to have associated injuries which affected treatment priorities. TAE was highly successful in controlling hemorrhage.

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