{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T17:45:12Z","timestamp":1768585512016,"version":"3.49.0"},"reference-count":17,"publisher":"Springer Science and Business Media LLC","issue":"5","license":[{"start":{"date-parts":[[2022,4,16]],"date-time":"2022-04-16T00:00:00Z","timestamp":1650067200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,4,16]],"date-time":"2022-04-16T00:00:00Z","timestamp":1650067200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Eur J Trauma Emerg Surg"],"published-print":{"date-parts":[[2022,10]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Purpose<\/jats:title>\n                <jats:p>To assess physical examination findings related to maxillofacial trauma to identify patients at risk of midfacial and mandibular fractures and then to construct a clinical decision aid to rule out the presence of midfacial and mandibular fractures in emergency department patients.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We performed a prospective multicentre cohort study in four hospitals in the Netherlands, including consecutive patients with maxillofacial trauma. Each patient received a standardized physical examination consisting of 15 and 14 findings for midfacial and mandibular traumas, respectively. Consequently, clinical decision aids were constructed with the focus being on ruling out the presence of midfacial and mandibular fractures, and diagnostic accuracy was calculated.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>A total of 993 consecutive patients were identified of whom 766 and 280 patients were suspected of midfacial and mandibular fractures, respectively. Midfacial fractures were diagnosed in 339 patients (44.3%), whereas mandibular fractures were observed in 66 patients (23.6%). The decision aid for midfacial trauma consisting of peri-orbital hematoma, epistaxis, ocular movement limitation, infra-orbital nerve paresthesia, palpable step-off and tooth mobility or avulsion, produced a sensitivity of 89.7 (86.0\u201392.5), a specificity of 42.6 (38.0\u201347.4), and a negative predictive value of 83.9% (78.4\u201388.2). The decision aid for mandibular trauma consisting of the angular compression test, axial chin pressure test, objective malocclusion, tooth mobility or avulsion and the tongue blade bite test resulted in a sensitivity of 98.5 (91.9\u201399.7), a specificity of 34.6 (28.5\u201341.2), and a negative predictive value of 98.7% (92.8\u201399.8).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>The constructed clinical decision aids for maxillofacial trauma may aid in stratifying patients suspected for midfacial and mandibular fractures to reduce unnecessary diagnostic imaging.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Clinical Trial Registration<\/jats:title>\n                <jats:p>The study was registered at ClinicalTrials.gov with the identifier NCT03314480.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s00068-022-01968-1","type":"journal-article","created":{"date-parts":[[2022,4,16]],"date-time":"2022-04-16T19:03:33Z","timestamp":1650135813000},"page":"4243-4254","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["A clinical decision aid for patients with suspected midfacial and mandibular fractures (the REDUCTION-I study): a prospective multicentre cohort study"],"prefix":"10.1007","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0594-8012","authenticated-orcid":false,"given":"Romke","family":"Rozema","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6186-7757","authenticated-orcid":false,"given":"Mostafa El","family":"Moumni","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gysbert T.","family":"de Vries","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0200-2344","authenticated-orcid":false,"given":"Frederik K. L.","family":"Spijkervet","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ren\u00e9","family":"Verbeek","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jurrijn Y. J.","family":"Kleinbergen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bas W. J.","family":"Bens","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2619-8903","authenticated-orcid":false,"given":"Michiel H. J.","family":"Doff","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5642-8194","authenticated-orcid":false,"given":"Baucke","family":"van Minnen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"the REDUCTION study group","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,4,16]]},"reference":[{"key":"1968_CR1","doi-asserted-by":"publisher","first-page":"2277","DOI":"10.1056\/NEJMra072149","volume":"357","author":"DJ Brenner","year":"2007","unstructured":"Brenner DJ, Hall EJ. Computed tomography-an increasing source of radiation exposure. N Engl J Med. 2007;357:2277\u201384.","journal-title":"N Engl J Med"},{"key":"1968_CR2","doi-asserted-by":"publisher","first-page":"1270","DOI":"10.1097\/PRS.0b013e3182043ad8","volume":"127","author":"TJ Sitzman","year":"2011","unstructured":"Sitzman TJ, Hanson SE, Alsheik NH, Gentry LR, Doyle JF, Gutowski KA. Clinical criteria for obtaining maxillofacial computed tomographic scans in trauma patients. Plast Reconstr Surg. 2011;127:1270\u20138.","journal-title":"Plast Reconstr Surg"},{"key":"1968_CR3","doi-asserted-by":"publisher","first-page":"1199","DOI":"10.1097\/SCS.0000000000001712","volume":"26","author":"TJ Sitzman","year":"2015","unstructured":"Sitzman TJ, Sillah NM, Hanson SE, Gentry LR, Doyle JF, Gutowski KA. Validation of clinical criteria for obtaining maxillofacial computed tomography in patients with trauma. 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J Craniofac Surg. 2018;29:e167\u201370.","journal-title":"J Craniofac Surg"},{"key":"1968_CR6","doi-asserted-by":"publisher","first-page":"1313","DOI":"10.1097\/TA.0b013e318265cf61","volume":"73","author":"K Yadav","year":"2012","unstructured":"Yadav K, Cowan E, Haukoos JS, Ashwell Z, Nguyen V, Gennis P, et al. Derivation of a clinical risk score for traumatic orbital fracture. J Trauma Acute Care Surg. 2012;73:1313\u20138.","journal-title":"J Trauma Acute Care Surg"},{"key":"1968_CR7","doi-asserted-by":"publisher","first-page":"e661","DOI":"10.1097\/SCS.0000000000003823","volume":"28","author":"P Scolozzi","year":"2017","unstructured":"Scolozzi P, Jacquier P, Courvoisier DS. Can clinical findings predict orbital fractures and treatment decisions in patients with orbital trauma? Derivation of a simple clinical model. 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Re-evaluating the diagnostic accuracy of the tongue blade test: Still useful as a screening tool for mandibular fractures? J Emerg Med Elsevier Ltd. 2013;45:8\u201312.","journal-title":"J Emerg Med Elsevier Ltd"},{"key":"1968_CR17","doi-asserted-by":"publisher","first-page":"925","DOI":"10.1007\/s12663-015-0778-1","volume":"14","author":"GC Rajkumar","year":"2015","unstructured":"Rajkumar GC, Ashwin DP, Singh R, Prashanth R, Rudresh KB. Ocular injuries associated with midface fractures: a 5 year survey. J Maxillofac Oral Surg Springer India. 2015;14:925\u20139.","journal-title":"J Maxillofac Oral Surg Springer India"}],"container-title":["European Journal of Trauma and Emergency Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00068-022-01968-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00068-022-01968-1\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00068-022-01968-1.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,10,4]],"date-time":"2022-10-04T18:14:20Z","timestamp":1664907260000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00068-022-01968-1"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,4,16]]},"references-count":17,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2022,10]]}},"alternative-id":["1968"],"URL":"https:\/\/doi.org\/10.1007\/s00068-022-01968-1","relation":{},"ISSN":["1863-9933","1863-9941"],"issn-type":[{"value":"1863-9933","type":"print"},{"value":"1863-9941","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,4,16]]},"assertion":[{"value":"10 October 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"26 March 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 April 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare that they have no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The Medical Ethical Committee of the University Medical Center Groningen confirmed that the Medical Research Involving Human Subjects Act does not apply (METc code 2016\/470) and local feasibility was approved for the Isala hospitals (METC171208) and Nij Smellinghe hospital (MEC6383\/JS\/AB). The study was performed in compliance with the Declaration of Helsinki and the FEDERA (Foundation Federation of Dutch Medical Scientific Societies) code of conduct.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and informed consent"}}]}}