Prevalence and factors associated with nasal fractures among patients with head trauma at Mulago National Referral Hospital

Abstract

Introduction: Nasal fractures are the most common type of facial fractures contributing 40 - 58% of all facial fractures. Although very common, their assessment and management is rarely included in the routine care of patients with head trauma yet these may be associated with co-existing life-threatening injuries such as traumatic brain injury. Delayed or missed diagnosis and management of these fractures may lead to sequelae such as nasal airway compromise and secondary deformity; functional and cosmetic defects that negatively impact the quality of life of affected victims. Objectives: To determine the prevalence and factors associated with nasal fractures among patients with head trauma at Mulago National Referral Hospital (MNRH). Methods: A cross-sectional study design was employed to achieve the study objectives. A structured questionnaire was used to collect data on sociodemographic and clinical characteristics of the study participants. Stata version 17 was used for statistical analysis with Modified Poisson model used to assess the factors associated with nasal fractures among patients with head trauma. Results A total of 162 patients with head trauma were enrolled, 158 (97.5%) males and 4 (2.5%) females. The median age was 29 years (range 18-75 years). 100 (61.7%) of the patients were involved in RTA by boda-boda, of these, 83% were riders and 81% had no helmets. The prevalence of nasal fractures was 53.1%. Having had a frontal impact PR,1.93(1.38-2.69, p<0.001), epistaxis PR,1.95(1.19-3.18, p=0.008) and impaired nasal breathing PR, 1.38(1.10-1.75, p=0.005) were associated with increased likelihood of nasal fractures in head trauma. Whereas having TBI reduced the likelihood of nasal fractures in head trauma 0.52(0.40-0.66, p<0.001). Conclusion There is a high prevalence (53.1%) of nasal fractures among head trauma patients, Majority resulting from motorcycle accidents and interpersonal violence. Having a frontal impact, epistaxis and impaired nasal breathing increased the likelihood of nasal fractures while having TBI reduced the likelihood. There is need to address road safety measures to mitigate the incidence of nasal fractures in head trauma.