Injury Patterns and Physiologic Risk Stratification in Facial Trauma Patients with Orbital Fractures: A National Trauma Database Analysis.

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-mechanism 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 (2018-2020). A three-component physiological risk score was developed using admission vital signs: severe hypotension (<90 mmHg, 2 points), tachycardia (>100 bpm, 1 point), and severe traumatic brain injury (GCS ≤ 8, 1 point). Risk stratification performance was validated against composite adverse outcomes.

RESULTS

Distinct age-mechanism patterns emerged: 74.0% of elderly patients (≥65 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: 0.78-0.80).

CONCLUSIONS

Age-mechanism 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.