In the validation process of the checklist also an exploratory study was performed in a pilot test stage with the objective to describe the profile of study participants. The data found in this study are similar those already published on literature what the majority of the victim of facial trauma are male, with age on second or third decade of life, without marital bond, low income and low education, rural works and victims of traffic accidents [19–21]. All these studies are from Brazil and the results may reflect the reality of its population. The anatomical location of the fracture mostly in this study was the mandible and this information corroborate previous systematic review about epidemiological characteristics of facial trauma in Brazil [22]. Probably, the mandible is commonly fractured due the traffic accidents be etiological factor more prevalence and involve trauma of higher impact.
As previously introduced, the checklist was created for avoiding under-estimation of an injury on face [9] and allow complete documentation of sign and symptoms in initial exam from patients [5]. Missed diagnoses result from failure to consider all possibilities that could be avoided if a sense of urgency to explore all potentials be used [6]. Besides, the documentation is important to identify treatable injuries in a timely fashion, minimize morbidity and as documents for civil or criminal proceedings arising from facial trauma [3]. The use of the checklist in addition to the scoring systems in the assessment of maxillofacial trauma allow an suitable urgent triage in the treatment of different existing facial fractures [9, 23–28].
Despite of advantages outline, it is necessary to know the context in which e-checklists are implemented [6]. Paper checklist can fatigue the professionals reducing the use of this instrument [28]. The present time is a digital or information age which electronic medical records (EMR) have been implemented and prioritized over the last decade [6]. They allow agility in register of information, environmental awareness, decrease in financial cost a long time and improve on documentation [6, 29]. In this situation, the smartphone is a mobile device that has permeated into healthcare [16]. This device improving access to health information for maxillofacial surgeons, although still there is a small number of apps specific to OMFS [14, 16, 30]. There is an endorsement of the new technology within OMFS and beside this the CAITOM® was developed.
Mobile applications, such as this one, and other technological developments are encouraged by health systems [32] and together with the EMR it is used to improve the quality of information for care transfers [33]. The CAITOM® is app done to be used amongst students, juniors or seniors’ residents, or specialty trainees that wish to make a holistic assessment of the patient with facial trauma. However, because the app is specific for diagnose process in OMFS is important that the surgeon known the technical terms in the field. This checklist does not replace the clinical record because is additional for the clinical exam and it should be used in physical exam section.
The information should be added in CAITOM® by the user at the same time of the patient’ evaluated avoiding errors or memory lapses. In the end, a pdf file will be created with all information targets found in this assessment and following that they are excluded from the mobile application. This way, confidential user data are protected and allow the privacy of the information recorded is. Mobile technologies cannot replace direct contact with the patient but can contribute to the rapid diagnosis and allow for timely referral to appropriate specialist [31]. The CAITOM® does not determine the diagnosis by itself but the information recorded in it together with other clinical data and complementary exams will allow a more accurate diagnosis to be formulated.
To the best of our knowledge, there is not study about the development of mobile applications with purpose of help in the initial assessment of maxillofacial trauma. This preliminary study introduces the CAITOM® app and encourages its use by the services of OMFS and that more researches be made with this app.