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Discordance between Clinical Diagnosis and Reading of Computerized Tomography in Nasal Bone Fracture  

Kim, Dong-Hyun (Department of Plastic Surgery, Inha University College of Medicine)
Hwang, Kun (Department of Plastic Surgery, Inha University College of Medicine)
Publication Information
Archives of Plastic Surgery / v.37, no.4, 2010 , pp. 375-379 More about this Journal
Abstract
Purpose: The nasal bone is the most frequently fractured facial bone. Discordance between the CT reading by the radiologist and the diagnosis by the plastic surgeon is not uncommon. This study examined the discordance and proposes a method for reducing the rate of discordance. Methods: The CT readings by the radiologist were compared with the diagnosis by the plastic surgeon in 716 patients with a clinically suspected nasal bone fracture. The CT reading was classified as the following: a nasal bone fracture, suspicious nasal bone fracture, old nasal bone fracture, no nasal bone fracture. The sensitivity, specificity and positive predictive value of the CT reading were calculated. Results: A nasal bone fracture was diagnosed in 646 patients by the plastic surgeon and confirmed intraoperatively. The reading of a "nasal bone fracture", "suspicious nasal bone fracture", "old nasal bone fracture" and "no nasal bone fracture" was 85.8%, 4.6%, 0.6% and 9.1% respectively. The sensitivity and specificity of the CT reading were 95.0% and 92.9%, respectively. The positive predictive value of the CT reading was 99.3%. The reading of "nasal bone fracture" that was not a nasal bone fracture clinically was 17.1% (12 of 70), and the reading of "no nasal bone fracture" or "old nasal bone fracture" that was found to be a nasal bone fracture clinically was 3.3% (21 of 646). The discordance rate between the CT reading by the radiologist and the diagnosis by the plastic surgeon was 4.6%. Conclusions: To reduce the discordance rate, we propose to hold a meeting with the plastic surgery-radiology staff to communicate the information regarding a suspicious or old nasal bone fracture.
Keywords
Fractures, Nasal bone; Radiology; X-Ray computed tomography;
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1 Hwang K, You SH, Kim SG, Lee SI: Analysis of nasal bone fractures; a six-year study of 503 patients. J Craniofac Surg 17: 261, 2006   DOI   ScienceOn
2 de Lacey GJ, Wingnall BK, Hussain S, Reidy JR: The radiology of nasal injuries: problems of interpretation and clinical relevance. Br J Radiol 50: 412, 1977   DOI   ScienceOn
3 Kim JE, Lee SW, Lee JK, Chung SH: Sonographic evaluation of nasal bone fractures. J Korean Radiol Soc 43: 95, 2000   DOI
4 Hideto I, Yoichiro H, Tomoaki S, Likinobu T, Takashi O, Masayuki K: Unhealed old maxillary fracture left for 12 years in a 34-year-old man. Oral Radiol 20: 80, 2004.   DOI   ScienceOn
5 Lee MH, Cha JG, Hong HS, Lee JS, Park SJ, Paik SH, Lee HK: Comparison of high-resolution ultrasonography and computed tomography in the diagnosis of nasal fractures. J Ultrasound Med 28: 717, 2009   DOI
6 Lee HJ, Na YC, Yoo SG: Comparison of computerized tomography (CT) and ultrasonography (US) in the diagnosis of nasal bone fracture and medial orbital wall fracture. J Korean Cleft Palate Craniofac Assoc 3: 55, 2002.
7 Kwon TK, Cha JH, Kim YW: Ultrasonographic diagnosis of nasal bone fractures. J Korean Soc Plast Reconstr Surg 23: 685, 1996.