(72) An Analysis of Maxillofacial Trauma and Toxicology Screens: A Social Determinate of Health Study

Abstract: Substance use is a common finding among patients sustaining facial fractures at Northwell Trauma Centers. Alcohol, tetrahydrocannabinol (THC), and cocaine are some of the more common substances linked to traumatic facial injuries. Among the patients testing positive for substance use, common mechanisms of injury include fall, assault, motor vehicle collisions, and pedestrian/bicycle strike. Many of the risk factors that contribute to facial trauma are outcomes of social determinants of health, particularly among those patients resulting from assault, as those with lower socioeconomic status are often associated with higher rates of interpersonal violence. This study sought to investigate the influence of alcohol and drug use on the pattern of patient attributes of maxillofacial trauma patients within Northwell Health Trauma Centers.This retrospective study assessed an overall 3,726 patients. The study compared urine toxicology and blood alcohol concentration in facial fracture patients at Northwell Trauma Centers from January 1, 2018, to December 31, 2023. Data were acquired through admission/discharge information within the Northwell Health Trauma Institute database. Patient demographics, blood alcohol concentration (BAC), drug screen via urine toxicology, mechanism of injury, fracture types, and length of stay were compared via independent samples t-tests and ANOVA analyses.There were 2,884 patients who sustained facial fractures that did not have any alcohol or drugs as opposed to 842 patients who sustained facial fracture with a positive BAC and/or drug screen. There was a significant association between gender and positive alcohol and/or drug screen, as 79% of the patients with a positive alcohol/drug screen were male, while 59% of the patients with no alcohol/drugs were male (P < .01). There was an increase in average length of stay for patients with positive BAC and/or drug screen compared to those without (5.73 days vs. 4.24 days, P < .01). The most common etiology of injury for patients with isolated positive BAC was fall (46%), while the most common etiology of injury for patients with isolated positive drug screen was assault (28%). Regardless of gender, age distribution, and substance vs no substance use, the predominant race in all categories were white. Further, white females were >5x more likely than non-white females to sustain a facial fracture through a fall. For females 71 and up, white females were 12x more likely than non-white females to sustain a facial fracture through a fall. Overall, in patients < 70 years of age, epidemiology and demographics of patients sustaining facial trauma saw considerable differences when substance use was involved. In patients >70 years of age, racial demographics of patients sustaining facial trauma showed a significant difference between white and non-white females. These disparities could be due to white females being at a higher risk of osteoporosis or a socioeconomic difference of females at this age that needs further exploration. Furthermore, the data showed that the highest incidence of fractures were patients who tested positive for alcohol, and a large amount of these patients were not tested for other substances. This data supports that all patients in the emergency department who test positive for alcohol should also be screened for other substances as these substances could have further detrimental effects of patients are taken for procedures. Overall, the results of these studies show the need for further at-risk patient awareness campaigns as well as increased hospital and healthcare resources for higher risks groups. References >1. de Jager, E., & Ho, Y. H. (2022). Socioeconomic disparities in rates of facial fracture surgeries for women and men at a regional tertiary care centre in Australia. ANZ journal of surgery, 92(7-8), 1700–1705. https://doi.org/10.1111/ans.17763 2. Murphy D. A. (2010). Substance use and facial injury. Oral and maxillofacial surgery clinics of North America, 22(2), 231–238. https://doi.org/10.1016/j.coms.2010.01.005

Overall Demographics
Fracture Incidence per Substance Tested
Female Fracture Incidence