{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T23:22:53Z","timestamp":1792797773539,"version":"4.5.0"},"reference-count":24,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T00:00:00Z","timestamp":1764979200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["CMTR"],"abstract":"<jats:p>Background: Although orbital fractures are common in trauma care, age-specific mechanisms and admission physiology-based risk stratification have not been systematically characterized. This study aimed to identify age\u2013mechanism interaction patterns and develop an admission-based physiological risk score for orbital fracture patients. Methods: This retrospective cohort study analyzed 41,464 adult orbital fracture patients from the National Trauma Data Bank (2018\u20132020). A three-component physiological risk score was developed using admission vital signs: severe hypotension (&lt;90 mmHg, 2 points), tachycardia (&gt;100 bpm, 1 point), and severe traumatic brain injury (GCS \u2264 8, 1 point). Risk stratification performance was validated against composite adverse outcomes. Results: Distinct age\u2013mechanism patterns emerged: 74.0% of elderly patients (\u226565 years) sustained falls, while young adults demonstrated a bimodal distribution with motor vehicle crashes (31.2%) and violence (28.4%). Violence-related injuries occurred in younger patients (40.3 vs. 55.0 years) but had lower injury severity scores (10.0 vs. 14.4) and mortality (2.8% vs. 5.2%) than accidental mechanisms. High-\/critical-risk patients (8.4% of the cohort) had 16.2% mortality versus 2.1% in stable patients. Complex facial injuries demonstrated 11-fold higher mortality (7.7% vs. 0.7%). The physiologic risk score achieved AUC 0.79 (95% CI: 0.78\u20130.80). Conclusions: Age\u2013mechanism interactions revealed distinct bimodal injury patterns in young adults. Admission physiologic parameters effectively identify 8.4% of patients requiring intensive resources, while violence-related injuries paradoxically demonstrate better outcomes than accidental mechanisms.<\/jats:p>","DOI":"10.3390\/cmtr18040052","type":"journal-article","created":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T10:35:51Z","timestamp":1765190151000},"page":"52","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Injury Patterns and Physiologic Risk Stratification in Facial Trauma Patients with Orbital Fractures: A National Trauma Database Analysis"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0252-7247","authenticated-orcid":false,"given":"Turki Bin","family":"Mahfoz","sequence":"first","affiliation":[{"name":"Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh 13317-4233, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,6]]},"reference":[{"key":"ref_1","first-page":"102","article-title":"Ocular damage in craniofacial-orbital trauma: About 170 cases","volume":"4","author":"Abounaceur","year":"2023","journal-title":"J. Ophthalmol. Allied Res."},{"key":"ref_2","first-page":"289","article-title":"Domestic violence-related ocular injuries among adult patients: Data from the Nationwide Emergency Department Sample, 2008\u20132017","volume":"30","author":"Andoh","year":"2023","journal-title":"Ophthalmic Epidemiol."},{"key":"ref_3","first-page":"78","article-title":"Orbital fractures: Incidence and significance of imaging","volume":"3","author":"Araujo","year":"2023","journal-title":"Int. J. Front. Med. Surg. Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1186\/s13005-023-00393-y","article-title":"Psychiatric disorders and interventions in patients sustaining facial fractures from interpersonal violence","volume":"19","author":"Arpalahti","year":"2023","journal-title":"Head Face Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1097\/PRS.0000000000008292","article-title":"Refining indications for orbital floor fracture reconstruction: A risk-stratification tool predicting symptom development and need for surgery","volume":"148","author":"Basta","year":"2021","journal-title":"Plast. Reconstr. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1097\/00005373-198905000-00017","article-title":"A revision of the Trauma Score","volume":"29","author":"Champion","year":"1989","journal-title":"J. Trauma."},{"key":"ref_7","first-page":"701","article-title":"Facial fracture-associated intracranial hemorrhage in the elderly population","volume":"85","author":"Dobitsch","year":"2019","journal-title":"Am. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1097\/01.shk.0000239772.18151.18","article-title":"Post-traumatic hypotension: Should systolic blood pressure of 90-109 mmHg be included?","volume":"27","author":"Edelman","year":"2007","journal-title":"Shock"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1097\/SCS.0000000000009163","article-title":"Pediatric orbital fractures: Outcomes in relation to time of surgery","volume":"34","author":"Gudnadottir","year":"2023","journal-title":"J. Craniofacial Surg."},{"key":"ref_10","first-page":"111209","article-title":"Epidemiology of ophthalmic trauma in the United States from 2009\u20132018: A nationwide emergency department sample analysis","volume":"54","author":"Iftikhar","year":"2023","journal-title":"Injury"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1234","DOI":"10.1097\/SCS.0000000000010236","article-title":"Pediatric facial fractures: Demographics, injury patterns, and associated injuries in 3334 patients","volume":"35","author":"Irgebay","year":"2024","journal-title":"J. Craniofacial Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3376","DOI":"10.2147\/OPTH.S376447","article-title":"Incidence and characteristics of orbital hemorrhages in the United States from 2006 to 2018","volume":"16","author":"Jensen","year":"2022","journal-title":"Clin. Ophthalmol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"R191","DOI":"10.1186\/cc10348","article-title":"Revised trauma scoring system to predict in-hospital mortality in the emergency department: Glasgow Coma Scale, age, and systolic blood pressure score","volume":"15","author":"Kondo","year":"2011","journal-title":"Crit. Care"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2889","DOI":"10.1111\/jocd.13385","article-title":"Involvement of orbit in maxillofacial fractures: \u201cEvaluation of its spectrum, characteristics, and treatment in 200 patients\u201d\u2014Prospective study","volume":"19","author":"Lin","year":"2020","journal-title":"J. Cosmet. Dermatol."},{"key":"ref_15","first-page":"123","article-title":"Assault-related orbital trauma at an urban Level I trauma center: Racial segregation and other neighborhood-level social determinants","volume":"39","author":"Mancera","year":"2022","journal-title":"Ophthalmic Plast. Reconstr. Surg."},{"key":"ref_16","first-page":"234","article-title":"Incidence of ophthalmologic pathology and associated risk factors in orbital fractures at a level I trauma centre","volume":"58","author":"Nassrallah","year":"2023","journal-title":"Can. J. Ophthalmol."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"O\u2019Brien-Coon, D., and Redett, R.J. (2020). Superior pediatric orbital and frontal skull fractures. Pediatric Plastic Surgery, Elsevier.","DOI":"10.1016\/B978-0-323-49755-8.00031-1"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1834","DOI":"10.1097\/SCS.0000000000003823","article-title":"Can clinical findings predict orbital fractures and treatment decisions in patients with orbital trauma? Derivation of a simple clinical model","volume":"28","author":"Scolozzi","year":"2017","journal-title":"J. Craniofacial Surg."},{"key":"ref_19","first-page":"291","article-title":"Patterns and trends of facial fractures at a tertiary care trauma center in India\u2014 A 13 years retrospective study","volume":"15","author":"Shome","year":"2022","journal-title":"Craniomaxillofacial Trauma Reconstr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"13","DOI":"10.30978\/GS-2022-2-13","article-title":"Predicting lethal outcome risks in patients with craniomaxillofacial trauma and polytrauma by the ISS and NISS","volume":"2","author":"Shumynskyi","year":"2022","journal-title":"Gen. Surg."},{"key":"ref_21","first-page":"1234","article-title":"Predictors of surgical versus medical management of eyes in the setting of orbital fracture at an academic level I trauma center","volume":"34","author":"Tamati","year":"2023","journal-title":"J. Craniofacial Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1016\/S0140-6736(74)91639-0","article-title":"Assessment of coma and impaired consciousness: A practical scale","volume":"2","author":"Teasdale","year":"1974","journal-title":"Lancet"},{"key":"ref_23","first-page":"111267","article-title":"Reverse shock index multiplied by Glasgow Coma Scale score as a point-of-care severity assessment for initial trauma management: A nationwide cohort study","volume":"54","author":"Uemura","year":"2023","journal-title":"Injury"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1313","DOI":"10.1097\/TA.0b013e318265cf61","article-title":"Derivation of a clinical risk score for traumatic orbital fracture","volume":"73","author":"Yadav","year":"2012","journal-title":"J. Trauma Acute Care Surg."}],"container-title":["Craniomaxillofacial Trauma &amp; Reconstruction"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1943-3883\/18\/4\/52\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,8]],"date-time":"2025-12-08T11:12:01Z","timestamp":1765192321000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1943-3883\/18\/4\/52"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,6]]},"references-count":24,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["cmtr18040052"],"URL":"https:\/\/doi.org\/10.3390\/cmtr18040052","relation":{},"ISSN":["1943-3883"],"issn-type":[{"value":"1943-3883","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,6]]}}}