Is there a simple facial trauma scale with true construct validity?
In this cadaveric tissue study, a bony facial trauma scale based only on reducible fractures was created and demonstrated high interrater reliability and construct validity based on a fundamental measure of facial trauma.
To our knowledge, this is the first facial trauma scale to be developed that has shown true construct validity.
The practice of facial trauma surgery would benefit from a useful quantitative scale that measures the extent of injury.
To develop a facial trauma scale that incorporates only reducible fractures and is able to be reliably communicated to health care professionals.
Design and Setting
A cadaveric tissue study was conducted from October 1 to 3, 2014. Ten cadaveric heads were subjected to various degrees of facial trauma by dropping a fixed mass onto each head. The heads were then imaged with fine-cut computed tomography. A Bony Facial Trauma Scale (BFTS) for grading facial trauma was developed based only on clinically relevant (reducible) fractures. The traumatized cadaveric heads were then scored using this scale as well as 3 existing scoring systems. Regression analysis was used to determine correlation between degree of incursion of the fixed mass on the cadaveric heads and trauma severity as rated by the scoring systems. Statistical analysis was performed to determine correlation of the scores obtained using the BFTS with those of the 3 existing scoring systems. Scores obtained using the BFTS were not correlated with dentition (95% CI, –0.087 to 1.053; P = .08; measured as absolute number of teeth) or age of the cadaveric donor (95% CI, –0.068 to 0.944; P = .08).
Main Outcome Measures
Facial trauma scores.
Among all 10 cadaveric specimens (9 male donors and 1 female donor; age range, 41-87 years; mean age, 57.2 years), the facial trauma scores obtained using the BFTS correlated with depth of penetration of the mass into the face (odds ratio, 4.071; 95% CI, 1.676-6.448) P = .007) when controlling for presence of dentition and age. The BFTS scores also correlated with scores obtained using 3 existing facial trauma models (Facial Fracture Severity Scale, rs = 0.920; Craniofacial Disruption Score, rs = 0.945; and ZS Score, rs = 0.902; P < .001 for all 3 models). In addition, the BFTS was found to have excellent interrater reliability (0.908; P = .001), which was similar to the interrater reliability of the other 3 tested trauma scales. Scores obtained using the BFTS were not correlated with dentition (odds ratio, .482; 95% CI, –0.087 to 1.053; P = .08; measured as absolute number of teeth) or age of the cadaveric donor (odds ratio, .436; 95% CI, –0.068 to 0.944; P = .08).
Conclusions and Relevance
Facial trauma severity as measured by the BFTS correlated with depth of penetration of the fixed mass into the face. In this study, the BFTS was clinically relevant, had high fidelity in communicating the fractures sustained in facial trauma, and correlated well with previously validated models.
Level of Evidence
Casale GGA, Fishero BA, Park SS, Sochor M, Heltzel SB, Christophel JJ. Classifying and Standardizing Panfacial Trauma With a New Bony Facial Trauma Score. JAMA Facial Plast Surg. 2017;19(1):23-28. doi:10.1001/jamafacial.2016.1105