Wisconsin Criteria and Necessity for Computed Tomography in Patients with Maxillofacial Trauma: A Diagnostic Value Study

Wisconsin criteria have already been introduced to diagnosis maxillofacial fractures and reduce unnecessary computed tomography (CT) and as a result radiation exposure. Given that its use in different centers has had different results, this study tries to investigate the diagnostic value of these criteria in a Level III trauma center.

Over the study period, all patients with facial trauma presenting to the hospital emergency evaluated for the study eligibility criteria. Maxillofacial CT in all patients was performed. A senior radiology resident who was blinded to the study reviewed the CT images. The diagnostic value of the Wisconsin criteria, including correct classification (CC), sensitivity (SEN) and specificity (SP), and positive and negative predictive values (NPV) was calculated.

A total of 300 patients most of whom were injured in traffic accidents (74%) met the inclusion criteria; most of whom were men (90.7%). The mean age of the patients was 33 years. The highest diagnostic value of the Wisconsin criteria is in identifying fractures in the frontal region with a CC of 80.2%. The SP and positive predictive value (PPV) of Wisconsin criteria at the cutoff point of 2 was 85.7% and 87.1%, respectively. SEN and NPV were obtained 23.9% and 21.8%, respectively.

Regarding poor obtained SEN and NPV and the not so high SP and PPV of the test, our study could not validate Wisconsin criteria for predicting facial fractures. It seems that these criteria are institutionally dependent and cannot be generalized to all medical centers.