Context

Anyone who has ever worked in an emergency department (ED) on a Friday night knows that facial injuries are a common presentation. In the 15-50 age group, the most common cause of facial fracture is interpersonal violence, at all other ages it is falls [1]. Not surprisingly, males outnumber females for facial fractures by a ratio of 2:1 [2]. Of all facial fractures, nasal fracture is by far the most common seen in the ED [1].

Although emergency medicine (EM) physicians encounter large numbers of patients with facial injuries, interpretation of facial x-rays, particularly injuries involving the zygoma, are a common source of diagnostic error in the ED [3]. While computed tomography is used frequently in trauma, plain x-rays remain relevant in the initial evaluation of potential isolated facial fractures.

Facial x-rays were the most commonly misinterpreted radiographs in one study of EM residents in the USA, leading to the most clinically significant errors from all x-ray misinterpretation [4].

Learning bite

Although facial injuries are one of the most common problems seen in the ED, interpretation of facial x-rays remains a frequent cause of diagnostic error.