Clinical evaluation of the nose: a cheap and effective tool for the nasal fracture diagnosis.

OBJECTIVE: An accurate diagnosis of nasal fracture is dependent on a thorough history and physical examination. The purpose of this investigation was to create a simple method to establish the diagnosis of nasal fracture based only on clinical criteria.

METHODS: A retrospective chart review was carried out of 220 patients suspected of nasal fracture admitted to a hospital specializing in occupational injuries in 2003 and 2004. Sensitivity, specificity, and positive/negative predictive value (PPV/NPV) were calculated for each clinical criterion (8), all the possible combinations of 2 clinical criteria (28) and 3 clinical criteria (56). The following clinical criteria were considered for the analysis: epistaxis, periorbital and/or perinasal ecchymosis, nasal wound or laceration, airway obstruction, nasal inflammation, lateral deviation, irregular nasal dorsum, and acute septal injury. Logisitic regression was used to assess statistical significance.

RESULTS: For any of the 8 criteria, the average sensitivity and negative predictive values for nasal fracture were very low (<35%). However, specificity and positive predictive values were relatively high (>90%) and increased, respectively, when at least 1 criterion was present (92% and 94%, respectively), when 2 clinical criteria were present (98% and 96%, respectively), and when at least 3 clinical criteria were present (100% for both).

CONCLUSIONS: The presentation of the clinical criteria can be a valuable method for the diagnoses of nasal fracture; nevertheless, when these clinical criteria are absent, the possibility of the nasal fracture cannot be ruled out though the possibility is remote.