Clinical Evaluation of the Nose: A Cheap and Effective Tool for the Nasal Fracture Diagnosis

OBJECTIVE An accurate diagnosis of nasal fracture is dependent on a thorough history and physical examination. The purpose of this investigation was to create a simple method to establish the diagnosis of nasal fracture based only on clinical criteria. METHODS A retrospective chart review was carried out of 220 patients suspected of nasal fracture admitted to a hospital specializing in occupational injuries in 2003 and 2004. Sensitivity, specificity, and positive/negative predictive value (PPV/NPV) were calculated for each clinical criterion (8), all the possible combinations of 2 clinical criteria (28) and 3 clinical criteria (56). The following clinical criteria were considered for the analysis: epistaxis, periorbital and/or perinasal ecchymosis, nasal wound or laceration, airway obstruction, nasal inflammation, lateral deviation, irregular nasal dorsum, and acute septal injury. Logisitic regression was used to assess statistical significance. RESULTS For any of the 8 criteria, the average sensitivity and negative predictive values for nasal fracture were very low (<35%). However, specificity and positive predictive values were relatively high (>90%) and increased, respectively, when at least 1 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). CONCLUSIONS The presentation of the clinical criteria can be a valuable method for the diagnoses of nasal fracture; nevertheless, when these clinical criteria are absent, the possibility of the nasal fracture cannot be ruled out though the possibility is remote.