Towards evidence based emergency medicine: best BETs from the Manchester Royal Infirmary

A short cut review was carried out to establish whether a reduced number of facial radiographs had acceptable clinical utility at detecting facial fractures after trauma. Altogether 614 papers were found using the reported search, of which five presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. A clinical bottom line is stated. Clinical scenario An 18 year old man has been assaulted and presents to the emergency department. He has a swollen, tender left zygoma and you would like to exclude an underlying fracture. The radiology department produce three views—the OM, OM30, and lateral. You wonder whether all three views are necessary to exclude a fracture. Three part question In a [patient with facial trauma] which [facial views] are necessary for [diagnosing facial fractures]? Search strategy Medline 1966-07/04 using the OVID interface. ([Exp Facial bones OR facial.mp OR exp Facial injuries] AND [exp Zygomatic fractures OR exp Fractures OR exp Maxillary fractures OR fracture$.mp] AND [exp X-Rays OR radiograph$.mp OR X ray.mp]) LIMIT to human AND English language. Search outcome Altogether 614 papers were found of which five were of some relevance to the clinical question. These five papers are shown in table 1. Comment(s) These studies vary in quality. c CLINICAL BOTTOM LINE Requesting one OM view in the emergency department will save cost, time, and radiation, however the evidence to date suggests that the emergency doctor may miss an occasional midfacial fracture. At least two views should be taken. Rogers SN, Bradley S, Michael SP. The diagnostic yield of only one occipito-mental radiograph in cases of suspected medfacial trauma—or is one enough? Br J Oral Maxillofac Surg 1995;33:90–2. Sidebottom AJ, Cornelius P, Allen PE, et al. Routine post-traumatic radiographic screening of midfacial injuries: is one view sufficient? Injury 1996;27: 311–13. Raby N, Moore D. Radiography of facial trauma, the lateral view is not required. Clin Radiol 1998;53:218–20. Sidebottom AJ, Lord TC. Single view radiographic screening of midfacial trauma. Int J Oral Maxillofac Surg 1998;27:356–7. McGhee A, Guse J. Radiography for midfacial trauma: is a single OM 15 radiograph as sensitive as OM15 and OM 30 combined? Br J Radiol 2000;73:883–5. 709 www.emjonline.com group.bmj.com on November 6, 2017 Published by http://emj.bmj.com/ Downloaded from