Association Between the Seat Belt Sign and Intra‐abdominal Injuries in Children With Blunt Torso Trauma in Motor Vehicle Collisions

Abstract

Objectives: The objective was to determine the association between the abdominal seat belt sign and intra-abdominal injuries (IAIs) in children presenting to emergency departments with blunt torso trauma after motor vehicle collisions (MVCs).Methods: This was a planned subgroup analysis of prospective data from a multicenter cohort study of children with blunt torso trauma after MVCs. Patient history and physical examination findings were documented before abdominal computed tomography (CT) or laparotomy. Seat belt sign was defined as a continuous area of erythema, ecchymosis, or abrasion across the abdomen secondary to a seat belt restraint. The relative risk (RR) of IAI with 95% confidence intervals (CIs) was calculated for children with seat belt signs compared to those without. The risk of IAI in those patients with seat belt sign who were without abdominal pain or tenderness, and with Glasgow Coma Scale (GCS) scores of 14 or 15, was also calculated.Results: A total of 3,740 children with seat belt sign documentation after blunt torso trauma in MVCs were enrolled; 585 (16%) had seat belt signs. Among the 1,864 children undergoing definitive abdominal testing (CT, laparotomy/laparoscopy, or autopsy), IAIs were more common in patients with seat belt signs than those without (19% vs. 12%; RR = 1.6, 95% CI = 1.3 to 2.1). This difference was primarily due to a greater risk of gastrointestinal injuries (hollow viscous or associated mesentery) in those with seat belt signs (11% vs. 1%; RR = 9.4, 95% CI = 5.4 to 16.4). IAI was diagnosed in 11 of 194 patients (5.7%;

Combined intra- and extraperitoneal urinary bladder rupture – a rare seat-belt injury: A case report

“…As the coexistence of a seat-belt sign and abdominal pain is associated with an increased risk of intraabdominal injuries [17] and considering the high mortality rates of TBR, ranging from 11% to 22% [4] , [18] , an immediate and adequate diagnostic approach followed by an appropriate therapy is indicated, while physicians should maintain a high level of suspicion for urologic injuries following blunt abdominal trauma.…”

Jejunal injuries in a young male’s blunt abdominal trauma

“…The presence of abdominal skin bruising may be indicative for visceral organ injuries. Several studies have pointed out, that bruising in a seat belt pattern was associated with intra-abdominal injury in 20-60% of cases [6]. The risk of perforated bowel injury increased by a 2.4 factor whenever seat belt bruising was detected [7].…”

Complicated Abdominal Seat Belt Injuries in Children

“…A planned sub-analysis of a prospective study of 12,000 children with blunt torso trauma had shown a greater risk for intra-abdominal injuries in patients with a seat belt sign than in those without a seat belt sign (relative risk, 1.6), and was largely indicative of an increased risk for gastrointestinal injuries (RR, 9.4). Children with seat belt signs had an increased risk for undergoing any acute interventions (RR, 4.5), including therapeutic laparotomy (RR, 9.5) [3]. Some evidences had shown a similar trend among the adult population.…”