Is the “Seat Belt Sign” Associated With Serious Abdominal Injuries in Pediatric Trauma?

Abstract

The SBS was not significantly associated with abdominal injury in our population. Patients without SBS had a higher Injury Severity Score and accounted for all of the deaths. SBS may not be as predictive of abdominal injury as previously reported.

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

“…21,24,25 One prior study, however, reported a similarly low rate of pediatric laparotomy as the current study. 26 The differences in the laparotomy rates noted in prior studies are likely due to different patient populations, study protocols (prospective vs. retrospective data collection), study definitions, and surgical practices. The laparotomy rate reported in the current study is from 20 different participating institutions and thus likely represents a more generalizable estimate during an era in which nonsurgical management of most pediatric abdominal injuries is favored.…”

“…25 In contrast, one pediatric study failed to demonstrate any association between the seat belt sign and intra-abdominal injury. 26 A large, prospective multicenter study regarding the implications of the seat belt sign in children has not previously been conducted.…”

“…25,31 Another study, however, suggested that the seat belt sign was not associated with abdominal injuries. 26 That study, however, consisted of a retrospective chart review that relied on physician documentation of a seat belt sign in the medical record. Prospective documentation of the seat belt sign likely increases the reliability of the findings and thus likely reflects a closer representation of the truth.…”

Blunt abdominal trauma in children

“…Even after addition of the presence of abdominal tenderness, the relative risk of an abdominal injury identified on computed tomography (CT) scan or during surgery was not significant [relative risk (RR) 1.6, 95% confidence interval (CI) 0.546-4.68] [6]. In another retrospective study of children with abdominal bruising after a MVC, a multivariate logistic regression analysis determined that predictors for intestinal injuries included abdominal bruising when combined with a pulse rate of more than 120 per minute, presence of free intra-abdominal fluid on ultrasound or CT, and an associated lumbar fracture.…”

Seat belt sign and its significance

“…[5] However, in unusual circumstances (high velocity motor vehicle collisions) these safety measures (seat belts) can be the source and cause of serious injuries. [6789] Kulowski and Rost[10] in 1956 first described seat belt-related injuries. Garrett and Braunstein[8] described the “seat belt syndrome” as early in 1962, but Doersch and Dozier[9] discussed the term “seat belt sign” in 1968.…”