D106. The Face of Risk: Identifying Key Risk Factors for Acute Hospital Course with Pediatric Craniofacial Fractures: A Pediatric Trauma Database Analysis

PURPOSE: This study delineates the epidemiology of pediatric craniofacial fractures and identifies risk factors for greater acuity using a national pediatric trauma database. METHODS: Utilizing the National Trauma Data Bank, pediatric craniofacial fractures admitted between 2010-2019 were identified. Descriptive analyses and multivariable regression were performed to identify risk factors for acute-level hospital course, including ICU admission, intracranial injury, tracheostomy, and cervical spine (C-spine) fracture. RESULTS: A total of 155,136 pediatric craniofacial fracture cases were reviewed, including cranial vault (49.0%), nasal (22.4%), midface (21.0%), mandibular (20.2%), and orbital floor fractures (13.7%). Midface and orbital floor fractures occurred commonly as multi-craniofacial fractures. Cranial vault fractures were the most common among all age groups, but frequency declined with age. In contrast, facial fractures increased with age. Despite the inherent complexity of multi-craniofacial trauma, isolated fractures remained a concern for acute-level hospital course. Cranial vault and midface fractures had an increased risk of intracranial injury (P<0.001) and ICU admission (P<0.001). Mandibular and midface fractures had an increased risk for C-spine fracture (P<0.001) and tracheostomy (P<0.001). Patient and injury-specific risk factors among the fractures with the strongest association for each outcome-cranial vault and mandible-were identified. CONCLUSION: The incidence of cranial vault fractures appears to have an inverse relationship with age whereas the incidence of facial fractures appears in increase with age. Greater acuity appears to be associated with cranial, midface and mandibular fractures.