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Original Investigation
March 16, 2017

Traumatic Facial Injuries Among Elderly Nursing Home ResidentsNever Event or Frequent Occurrence?

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan
  • 2Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan
  • 3Department of Otolaryngology–Head and Neck Surgery, Rutgers New Jersey Medical School, Newark
  • 4Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
  • 5Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, Newark, New Jersey
  • 6Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark
  • 7Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, Wayne State University School of Medicine, Detroit, Michigan
  • 8Division of Otolaryngology, John Dingell Veterans Affairs Medical Center, Detroit, Michigan
JAMA Otolaryngol Head Neck Surg. Published online March 16, 2017. doi:10.1001/jamaoto.2016.4275
Key Points

Question  What are the incidence and mechanism of injury of facial trauma injuries sustained in the elderly nursing home population?

Findings  The National Electronic Injury Surveillance System was used to calculate incidence and characteristics of facial trauma among nursing home residents. The most common injuries were lacerations and other soft-tissue injuries and fractures, with nasal and orbital fractures the most common sites of fracture and direct contact with structural housing elements or fixed items and transfer to and from bed the most common injury causes.

Meaning  Despite falls being considered a Centers for Medicare & Medicaid Services preventable never event in hospitals, these injuries likely contribute substantially to health care expenditures and leave room for areas for intervention.

Abstract

Importance  As the nursing home population continues to increase, an understanding of preventable injuries becomes exceedingly important. Although other fall-related injuries have been characterized, little attention has been dedicated to facial trauma.

Objectives  To estimate the incidence of facial trauma among nursing home residents and detail mechanisms of injury, injury characteristics, and patient demographic data.

Design, Setting, and Participants  The National Electronic Injury Surveillance System was used to calculate a weighted national incidence of facial trauma among individuals older than 60 years from a nationally representative collection of emergency departments from January 1, 2011, through December 31, 2015. Entries were screened for nursing home residents, and diagnosis, anatomical site, demographic data, and mechanism of injury were analyzed.

Results  There were 109 795 nursing home residents (median age, 84.1 years; interquartile range, 79-89 years; 71 466 women [65.1%]) who required emergency department care for facial trauma. Women sustained a greater proportion of injuries with increasing age. The most common injuries were lacerations (48 679 [44.3%]), other soft-tissue injuries (45 911 [41.8%]; avulsions, contusions, and hematomas), and fractures (13 814 [12.6%]). Nasal (9331 [67.5%]) and orbital (1144 [8.3%]) fractures were the most common sites. The most common injury causes were direct contact with structural housing elements or fixed items (62 604 [57.0%]) and transfer to and from bed (24 870 [22.6%]).

Conclusions and Relevance  Despite falls being considered a Centers for Medicare & Medicaid Services preventable never event in hospitals, our analysis in the nursing home setting found more than 100 000 facial injuries during 5 years, suggesting these underappreciated injuries contribute substantially to health care expenditures. Although structural elements facilitated the greatest number of falls, transfer to and from bed remains a significant mechanism, suggesting an area for intervention.

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