Rendimiento de la evaluación clínica en el diagnóstico de fractura de huesos propios nasales

Abstract

Introduction: The aim of this study was to evaluate the performance of clinical assessment in the diagnosis of bone fractures in patients with nasal trauma. Methods: Retrospective review of medical records of 220 patients with nasal trauma treated at the Maxillofacial Surgery Department of Hospital Workers in Santiago was performed. Eight clinical criteria were evaluated: epistaxis, ecchymosis, swelling, nasal injury, airway obstruction, nasal deviation, irregular nasal dorsum, and acute septal injury. The gold standard for diagnosis of nasal fracture was the radiological evaluation. The sensitivity, specificity, and positive/negative predictive value (PPV/NPV) were calculated for each separate clinical criteria (8), for all possible combinations of 2 clinical criteria (28) and 3 clinical criteria (56). Results: For any of the 8 criteria, the average sensitivity and negative predictive values for nasal fracture was very low (< 35%). However, the specificity and positive predictive values were relatively high (> 90%) and increased, respectively, when at least one criterion was present (92% and 94% respectively), when 2 clinical criteria were present (98% and 96%, respectively), and when at least 3 clinical criteria were present (100% for both). Conclusion: The presentation of the clinical criteria can be a valuable method for diagnosis of nasal fracture, however, when these clinical criteria are absent, the possibility of nasal fracture cannot be excluded, although the possibility is remote.