Facial trauma and the risk of intracranial injury in motorcycle riders

Abstract

Study objective: We describe the associations among facial fracture, helmet use, skull fracture, and traumatic brain injury in injured motorcycle riders. Methods: The study population consisted of 5, 790 motorcycle riders who sustained an injury from a crash in 1991, 1992, or 1993 and were identified from emergency department or hospital records in 28 hospitals in 11 California counties. Diagnostic information was abstracted from ED or hospital records and coded to the 1990 Abbreviated Injury Scale. The risk of traumatic brain injury was examined by using odds ratios and 95% confidence intervals. Logistic regression analysis was used to examine the associations among helmet use, skull fracture, facial fracture, and traumatic brain injury. Results: Facial injury was diagnosed in 24.4% of all injured riders, including 411 with one or more facial fractures. The odds of traumatic brain injury were 3.5 times greater with than without a facial injury and 6.5 times greater with a facial fracture than with no facial injury. Significantly increased odds of traumatic brain injury were observed for fracture of all bones of the face, but the highest odds of traumatic brain injury were found in riders with fractures to bones of the upper face. Helmet use status and the presence of skull fracture were found to be significant effect modifiers. Facial fracture with concurrent skull fracture increased the risk of traumatic brain injury dramatically. Facial fractures are more strongly associated with traumatic brain injury in helmeted riders. Conclusion: The presence of facial fractures increases the risk of traumatic brain injury. Riders with facial fractures should be screened for brain injury, regardless of helmet use status.