GP1d - What Factors Influence Inpatient Admission for Mandible Fractures in Emergency Departments Across the United States?

Presenting Author(s)

• 

  Brendan Wu, DMD, MD, MMSc

  Resident
  Bellevue Hospital Center/NYU Langone Health
  New York, New York

Co-Author(s)

• 

  Vasiliki Karlis, DMD, MD

  Program Director, Associate Professor
  Bellevue Hospital Center/NYU Langone Health
  New York, New York
• KG

  Kim Goldman, NEW YORK, DMD

  Clinical Assistant Professor, Oral and Maxillofacial Surgery
  NYU Langone Health
  New York, New York

Abstract:
Statement of Problem:
Facial trauma surgeons who are consulted by emergency departments (ED) for mandible fractures must decide whether to admit the patient for inpatient surgical repair. The disposition is influenced by biological, situational, and socioeconomic factors, adding to its complexity. Admission allows for closer monitoring and may expedite surgery, while discharge reduces healthcare system strain and grants patients the flexibility of outpatient follow-up. This study aims to identify factors predictive of inpatient admission for mandible fractures presenting to emergency departments across the United States.
Materials and

Methods: This was a retrospective cohort study of the 2022 Nationwide Emergency Department Sample (NEDS). Patients diagnosed with mandible fractures (ICD-10-CM prefix S02.6) were included. Predictor variables were derived from patient, hospital, and injury characteristics. The primary outcome was inpatient admission from the emergency department. Univariate analyses were performed for all predictor variables, followed by bivariate analyses to assess associations between predictors and inpatient admission.
Results and Outcomes: A total of 12,160 patients with 16,596 mandible fractures met the inclusion criteria. Admitted patients were more likely to be male (RR = 1.08, P < .001) and elderly (RR = 1.19, P < .001). Body fractures were the most common (31.7%) but the least likely to result in admission (RR = 0.79, P < .001), whereas symphysis fractures had the highest likelihood of admission (RR = 1.87, P < .001). Coronoid fractures were the least common (2.1%) and were likely to be admitted (RR=1.24, P < .001). Patients with multiple mandible fractures (RR = 1.88, P < .001) and concomitant facial fractures (RR = 1.84, P < .001), particularly midfacial fractures (RR = 1.94, P < .001), were more likely to be admitted. Firearm injuries (RR = 1.22, P < .001), motor vehicle accidents (RR = 1.94, P < .001), and self-harm (RR = 2.29, P < .001) associated with higher likelihoods of admission. Patients presenting to Level I trauma centers (RR = 1.67, P < .001), teaching hospitals (RR = 2.14, P < .001), and public hospitals (RR = 1.15, P < .001) were more likely to be admitted. Southern hospitals had the most admissions (44.9%, P < .001). Public insurance increased the likelihood of admission (RR = 1.13, P < .001), while uninsured patients were less likely to be admitted (RR = 0.94, P = .007). Income quartile was not significantly associated with admission (P = .066). ED charges were significantly higher for admitted patients compared to those discharged ($15,511 vs $4,899, P < .001).


Conclusions: Mandible fractures impose a significant financial burden on emergency departments, with socioeconomic factors influencing inpatient admission rates. Patients with public insurance are more likely to be admitted, while those without insurance are more often discharged. Admission rates were higher for patients with indicators of high-energy trauma, including multiple mandible fractures, additional facial fractures, and firearm-related injuries. Teaching hospitals were more likely to admit mandible fractures, possibly to support surgical resident education.

References:
1. Hughes D, Ng SM, Smyth D, Patel H, Kent S, Henry A, Blore C, Dawoud B, Kumar D, Jefferies C, Kyzas P, Collaborators M. Emergency versus semi-elective management of mandible fractures: a Maxillofacial Trainee Research Collaborative (MTReC) study. Ann R Coll Surg Engl. 2023 May;105(5):461-468.
2. Yildirgan K, Zahir E, Sharafi S, Ahmad S, Schaller B, Ricklin ME, Exadaktylos AK. Mandibular Fractures Admitted to the Emergency Department: Data Analysis from a Swiss Level One Trauma Centre. Emerg Med Int. 2016;2016:3502902.
Figure 1. Distribution of Mandible Fracture Location in Emergency Department Visits. Figure 2. Relative Risk of Admission by Mandible Fracture Location. Table 6. Relative Risk of Admission for Mandible Fractures.