ToolsCalculators
Wisconsin Criteria for maxillofacial CT in trauma
Screens which blunt facial-trauma patients need dedicated maxillofacial CT.
Wisconsin Criteria for maxillofacial CT in trauma
Bony step-off or instability on palpation
Palpable deformity, mobility, or crepitus of the facial skeleton.
Periorbital swelling or contusion
Swelling, ecchymosis, or contusion around the eye.
GCS < 14
Any depressed level of consciousness limiting a reliable facial exam.
Malocclusion
Patient reports or demonstrates that the teeth no longer meet normally.
Tooth absence
Newly missing or avulsed teeth attributable to the injury.
Result0 of 5 criteria present
No criteria present - a clinically significant facial fracture is unlikely and dedicated facial CT can often be deferred, in the appropriate clinical context.
- Criteria positive
- 0 of 5
- Recommendation
- CT may be deferred
When to use
- Deciding whether a haemodynamically stable adult with blunt facial trauma needs a dedicated maxillofacial CT.
- As a rule-out screen - the tool is designed for high sensitivity, not to confirm a fracture.
Formula
Five findings, one point each: bony step-off/instability, periorbital swelling or contusion, GCS < 14, malocclusion, tooth absence. Any single positive finding (score >= 1) prompts dedicated maxillofacial CT.
Pearls and pitfalls
- The rule is a sensitivity-driven screen; a negative result argues against, but does not fully exclude, a facial fracture.
- External validations have reported variable sensitivity, so apply within local practice and alongside the wider trauma assessment.
- It addresses dedicated facial imaging - it does not govern head CT for intracranial injury, which follows its own decision rules.