Diagnostic accuracy of the tongue blade test combined with clinical signs to detect maxillary and mandibular fractures in the emergency department

To evaluate the diagnostic accuracy of clinical signs combined with the tongue blade test (TBT) to detect maxillary and mandibular fractures. A cross-sectional study enrolled patients with maxillary and mandibular injuries in the emergency department. Physical examination and the TBT were performed,...

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Bibliographic Details
Published in:World journal of emergency medicine 2023-03, Vol.14 (2), p.122-127
Main Authors: Kuck, Jee Yen, Azhar, Abdul Muhaimin Noor, Wee, Neena, Manikam, Rishya
Format: Article
Language:English
Subjects:
CT imaging
Emergency service
Hospitals
Medical research
Medicine, Experimental
Original
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Summary:To evaluate the diagnostic accuracy of clinical signs combined with the tongue blade test (TBT) to detect maxillary and mandibular fractures. A cross-sectional study enrolled patients with maxillary and mandibular injuries in the emergency department. Physical examination and the TBT were performed, followed by radiological imaging (facial X-ray or computed tomography [CT]). The diagnostic accuracy was calculated for individuals and a combination of clinical findings at predicting maxillary and mandibular fractures. A total of 98 patients were identified, of whom 31.6% had maxillary fractures and 9.2% had mandibular fractures. The combination of malocclusion, tenderness on palpation and swelling with positive TBT had 100% specificity to detect maxillary and mandibular fractures. In the absence of malocclusion, the combination of tenderness on palpation and swelling with positive TBT produced a specificity of 97.8% for maxillary fracture and a specificity of 96.2% for mandibular fracture. A clinical decision tool consisting of malocclusion, tenderness on palpation, swelling and TBT revealed a specificity of 100% and a positive predictive value of 100%. The clinical decision tool is potentially useful to rule out mandibular fractures, thus preventing unnecessary radiation exposure.
ISSN:1920-8642
DOI:10.5847/wjem.j.1920-8642.2023.032