Long-term Morbidity of Traumatic Brain Injury Following Facial Fracture.

Background: Traumatic brain injury (TBI) is underreported in craniofacial trauma patients, and the long-term morbidity of TBI associated with craniofacial trauma is poorly defined. Current literature is limited in scope to TBI identification in the immediate posttrauma time frame.

Methods: A retrospective, cohort analysis of adult facial fracture patients presenting from February 2022 to February 2023 was performed. Data were collected for demographics, mechanism of injury, fracture pattern, Glasgow Coma Score, admission status, operative intervention, and concomitant injuries. Rivermead Post Concussion Symptoms Questionnaire surveys were given for evaluation of TBI symptoms at most recent follow-up. Statistical significance was accepted when the P value was less than 0.05.

Results: Of 232 facial fracture patients, 82 (35%) completed the Rivermead Post Concussion Symptoms Questionnaire. The mean age was 49.8 years, and mean follow-up time was 11.6 months (range, 2-22 mo). The rate of all patients with TBI symptoms at follow-up was 32.9%. Mechanism of injury, presence of multiple fractures, Glasgow Coma Score less than 15, concomitant injuries, and admission status were not significant predictors of TBI. Fractures requiring operative intervention had higher rates of TBI compared with nonoperative fractures (47.1% versus 22.9%, P = 0.02). Operative intervention was the only significant predictor of TBI symptoms at the time of follow-up (odds ratio: 6.268; 95% confidence interval: 1.322-29.744; P = 0.021) by multivariable logistic regression.

Conclusions: Craniofacial trauma is associated with persistent TBI symptoms. Surgeons treating this trauma population should screen for TBI to facilitate disease identification and specialty referral.