Systemic injury extension and mechanism of trauma determine ICU admission in CT-confirmed maxillofacial fractures.

PURPOSE: To evaluate whether intensive care unit (ICU) admission in CT-confirmed maxillofacial trauma is primarily associated with facial fracture burden or with radiologically defined systemic injury extension.

METHODS

This retrospective cohort study included 1,511 patients with CT-confirmed maxillofacial fractures treated at a tertiary trauma center. Injury mechanism, fracture multiplicity (mFISS-face), and systemic extension (cranial and thoracic involvement) were assessed. Multivariable Firth penalized logistic regression was performed to identify independent predictors of ICU admission. Model discrimination, calibration, and internal validation were evaluated using AUC, calibration metrics, Brier score, and bootstrap resampling.

RESULTS

ICU admission occurred in 37 patients (2.45%). In multivariable analysis, age (aOR 1.04 per year, p < 0.001), traffic-related mechanism (aOR 2.74, p = 0.038), thoracic injury (aOR 25.08, p < 0.001), and cranial extension (aOR 98.24, p < 0.001) were independently associated with ICU admission. Fracture multiplicity demonstrated borderline significance (aOR 1.32, p = 0.071). The model showed good discrimination (optimism-corrected AUC 0.874), acceptable calibration (calibration slope 0.98), and low overall prediction error (Brier score 0.016).

CONCLUSION

In CT-confirmed maxillofacial trauma, ICU admission is predominantly associated with systemic injury extension—particularly cranial and thoracic involvement—rather than facial fracture burden alone. An imaging-based parsimonious model demonstrated stable performance and may support anatomy-informed ICU triage decisions. External validation is required prior to clinical implementation. CLINICAL TRIAL REGISTRATION: Not applicable.