2017-18 HSC Section 3 Green Book

T.N. Mansour et al. / American Journal of Emergency Medicine 35 (2017) 112 – 116

Con fl ict of interest

simple orbital fracture cases. This measurement can expedite consulta- tion with the appropriate subspecialists for more prompt and effective surgical intervention. This point cannot be further underscored because a few of the initial clinical examinations in our studies were seen by ophthalmology specialists who do not perform orbital fracture surgery. Many of the patient's evaluations in the emergency department were inadequate to reliably predict the possibility of surgery because of fac- tors such as extensive periorbital edema, subconjunctival hemorrhage, retrobulbar hemorrhage, and poor patient cooperation. This ultimately resulted in subsequent referral delays to oculoplastic specialists which risks delaying surgery. Limitations of this study include the retrospective nature of the study and the relatively small sample size. To avoid measurements biases, the CT reviewers were blinded to the patients' fi nal outcome. It should also be noted that thismeasurement only applies to those patients with isolat- ed BOFs and those with concomitant minor medial wall fractures. Patient's with obvious rectus entrapment noted on CT scan were exclud- ed and would not likely fi t the criteria presented here. The study does not attempt to suggest whether or not enophthalmos alone or enophthalmos with diplopia is more likely to occur in these patients as some previous studies have attempted to elucidate. The CCD maximizes our ability to identify the crucial area along the orbital fl oor that best predicts the largest, critical change in orbital vol- ume that will likely result in clinically signi fi cant enophthalmos and/or muscle restriction (example of calculation in Fig. 7 ). The CCD is an accurate and reliable measurement that can differen- tiate between patients with acute BOF who require earlier surgical in- terventions and those who would not. This technique can be used by radiologists and especially emergency medicine physicians to help in timely referral to orbital surgeons to treat such patients as effectively as possible. Surgical timing appears to in fl uence the complexity of the procedure and may ultimately determine the fi nal functional and aes- thetic outcome(s). This tool may be of highest impact to those rural emergency physicians who do not have the luxury of having available specialists for on-site consultation. 5. Conclusions

The authors declare that they have no con fl ict of interest.

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