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Multicenter Study
. 2024 Apr;50(2):543-550.
doi: 10.1007/s00068-023-02428-0. Epub 2024 Jan 10.

Maxillofacial haemorrhagic symptoms in emergency department patients: impact of antithrombotics

Pieter Date van der Zaag  1 , Stephanie Geurts  2 , Romke Rozema  3 , Inge H F Reininga  4   5 , Baucke van Minnen  6 ; REDUCTION study group members
Affiliations
Multicenter Study

Maxillofacial haemorrhagic symptoms in emergency department patients: impact of antithrombotics

Pieter Date van der Zaag et al. Eur J Trauma Emerg Surg. 2024 Apr.

Abstract

Purpose: To investigate the effect of antithrombotics on the occurrence of maxillofacial haemorrhagic symptoms, and to determine if these haemorrhagic symptoms are predictors of maxillofacial fractures.

Method: A prospective cohort study was conducted of consecutive patients with maxillofacial trauma who had been admitted to the emergency department of four hospitals in the Netherlands. This study compared five haemorrhagic symptoms (peri-orbital haematoma, raccoon eyes, epistaxis, subconjunctival ecchymosis, and intra-oral haematoma) between patients not-using (NUA) and using (UA) of antithrombotics, and whether these maxillofacial haemorrhagic symptoms served as predictors for maxillofacial fractures.

Results: Out of the 1005 patients, 812 (81%) belonged to the NUA group, and 193 (19%) to the UA group. UA patients exhibited higher frequencies of peri-orbital hematoma (54% vs. 39%, p < 0.001), raccoon eyes (10% vs. 5%, p = 0.01), and subconjunctival ecchymoses (16% vs. 7%, p < 0.001). In NUA, peri-orbital hematoma (OR = 2.5, p < 0.001), epistaxis (OR = 4.1, p < 0.001), subconjunctival ecchymosis (OR = 2.3, p = 0.02), and intra-oral hematoma (OR = 7.1, p < 0.001) were significant fracture predictors. Among UA, peri-orbital hematoma (OR = 2.2, p = 0.04), epistaxis (OR = 5.4, p < 0.001), subconjunctival ecchymosis (OR = 3.7, p = 0.008), and intra-oral hematoma (OR = 22.0, p < 0.001) were significant fracture predictors.

Conclusion: Maxillofacial haemorrhagic symptoms were observed more frequently in the UA group than in the NUA group. However, in both groups, maxillofacial haemorrhagic symptoms appear to be predictors of maxillofacial fractures. Caution is warranted in attributing these symptoms solely to antithrombotic use during emergency department assessments.

Keywords: Antithrombotics; Epistaxis; Intra-oral haematoma; Maxillofacial haematoma; Maxillofacial trauma; Peri-orbital haematoma; Subconjuctival eccymosis.

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Conflict of interest statement

Pieter Date van der Zaag, Stephanie Geurts, Romke Rozema, Inge H.F. Reininga, Baucke van Minnen and the REDUCTION study group members declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Total count of maxillofacial haemorrhagic symptoms per status of antithrombotic use. NUA, not using antithrombotics; UA, using antithrombotics
See this image and copyright information in PMC

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