Boxing-related maxillofacial and orbital trauma: a retrospective NEISS database analysis of injury patterns and emergency diagnostic prioritization (2014–2023)

Introduction/Background: Using the National Electronic Injury Surveillance System (NEISS) database, this study analyzes boxing-related maxillofacial and orbital injuries presenting to emergency departments nationwide, identifying injury patterns to better equip clinicians for accurate diagnosis and optimized patient outcomes. Objective(s): To characterize the distribution of boxing-related maxillofacial injuries requiring hospitalization from 2014–2023 and to establish evidence-based diagnostic and management priorities for emergency physicians, ophthalmologists, and surgeons. Methods — Design: Retrospective national database analysis. IRB approval was not required as only publicly available data were utilized. Setting: Statistically representative sample of U.S. hospital emergency departments via the NEISS database. Participants: Patients presenting to emergency departments with boxing-related head and neck injuries (eye, head, face, mouth, ear) from 2014–2023 (n = 1,012 maxillofacial hospitalizations from 37,203 total national admissions). Excluded: extremity/torso injuries; burns, toxicology, amputation, electroshock, or submersion. Interventions: Not applicable (observational/database study). Main Outcome Measures: Annual incidence of boxing-related maxillofacial injuries, anatomical distribution of injury location, frequency of specific diagnoses at hospitalization, and burden index (maxillofacial injuries per 1,000 boxing ER admissions). Results: Analysis of NEISS data from 2014–2023 revealed mandibular fractures (35%) and orbital floor blowout fractures (30%) as the predominant causes of hospitalized boxing-related maxillofacial injuries. Concussions accounted for 15%, followed by nasal septal hematomas (10%), subdural hematomas (5%), and other facial fractures (5%). Head (43.0%) and face (37.3%) together accounted for >80% of all admissions. A strong positive Pearson correlation was identified between ER admissions and maxillofacial injuries (r = 0.893, p = 0.0005). Diagnosis distribution was significantly non-uniform (χ² = 139.1, p < 0.001). Conclusion: These findings give emergency physicians and surgeons actionable diagnostic guidance for boxing-related trauma. The predominance of orbital floor blowout and mandibular fractures supports maxillofacial CT with fine-cut orbital views as the initial imaging modality, while altered mental status, concussive syndromes, or neurologic compromise should prompt non-contrast head CT to rule out acute intracranial hemorrhage. Recognizing these patterns enables faster, more accurate management of ophthalmic and maxillofacial injuries, reducing morbidity and improving outcomes.