Evidence map›Paper›PMID 40622420›Full record

Observational studyEuropean journal of trauma and emergency surgery : official publication of the European Trauma Society2025

Standardized clinical examination of maxillofacial injury: fracture diagnostic accuracy across experience levels.

Pieter Date van der Zaag, Romke Rozema, Inge H F Reininga, Baucke van Minnen, REDUCTION study group members

Abstract readObservational StudyMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in European journal of trauma and emergency surgery : official publication of the European Trauma Society, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Maxillofacial fractures associated with electric scooter trauma: a cohort study from a national level I trauma center.European journal of trauma and emergency surgery : official publication of the European Trauma Society · 2026
    Observational
  2. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Pieter Date van der ZaagDepartment of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. p.d.van.der.zaag@umcg.nl.
Romke RozemaDepartment of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Inge H F ReiningaDepartment of Trauma Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Baucke van MinnenDepartment of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
REDUCTION study group members

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeTo determine whether physicians can accurately assess maxillofacial injury patients for the presence of fractures using a standardized clinical examination protocol, and to evaluate differences in assessment accuracy across experience levels.

methodA prospective observational cohort study was conducted in four hospital emergency departments of patients with maxillofacial injuries. Physicians rated fracture probability twice on a 0-10 scale: first based on visual signs before the clinical examination, and again after the standardized clinical examination consisting of 15 midfacial or 14 mandibular parameters. The assessors were categorized as medical intern in training, junior resident, senior resident, or consultant. The patients were classified into four groups: midfacial or mandibular injury, with or without a fracture, as determined by radiographic results. The fracture probability ratings before and after the clinical examination were compared.

resultsOf 556 patients, 499 (90%) had midfacial injuries and 57 (10%) mandibular injuries. For midfacial injuries, greater variability in probability ratings and more incorrect assessments were observed compared to mandibular injuries. The intra-assessor analysis of fracture probability ratings before and after the clinical examination showed significant improvement in the direction of the eventual radiological diagnosis in three of the four patient groups for junior and senior residents, whereas the consultants, whose assessment was already proficient, only improved for one group, and none for interns. The inter-assessor analysis of fracture probability ratings showed no significant differences between the assessors.

conclusionMidfacial injuries are more difficult to assess than mandibular injuries, and junior and senior residents benefited the most from the standardized clinical examinations.

Indexed as

Clinical CompetenceMandibular FracturesMaxillofacial InjuriesPhysical ExaminationAdultEmergency Service, HospitalFemaleHumansInternship and ResidencyMaleMiddle AgedProspective StudiesClinical examinationMandibular injuryMaxillofacial injuryMidfacial injuryPhysician experience

Identifiers

PMID40622420
PMCPMC12234616

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.