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Likelihood Ratio (LR) in Emergency Medicine

9/15/2013

Low probability of mandibular fracture? C'mon grit your teeth!


Clinical Scenario

It’s a Saturday busy night, in ED when a 31 yo male comes referring pain in the chin and next to the right ear after a trauma. He was out celebrating his birthday, slipped and fell on to his chin. 
Vital signs are normal, there aren’t wounds, he denies malocclusion, the palpation of the anterior ear elicite little pain, there’s not trismus. The tongue and the teeths are intact. 
I’m tired- he says- is my mandibula OK?





I will answer in a little while, says the doctor armed with a tongue depressor.




  




Conclusion 

Missing a mandibular fracture can lead to serious long term complications. The absence of trismus or malocclusion, the absence of tenderness to palpation or swelling, decreases the pretest probability of a mandibular fracture. 
A negative tongue blade test lower a post test probability further of 45%.

Great!!!


Bibliography 

N.D.Caputo
Re-evaluating the diagnostic accuracy of the tongue blade test: still useful as a screening tool for mandibular fractures?
J Emerg Med 2013 vol 45 n1 pagg 8 – 12



Ciro Paolillo

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