Predictive indicators for bowel injury in pediatric patients who present with a positive seat belt sign after motor vehicle collision

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

“…20 In addition, the rate of gastrointestinal injuries in those with seat belt signs (11% of those undergoing definitive abdominal testing) was lower compared to the nearly 25% identified in prior studies. 24,25 The rate of pancreatic injuries in those with seat belt signs was only 1% in the current study, which is lower than the 7% in the prior prospective study. 25 The 9% rate of solid organ injuries in those with seat belt signs was identical to that in the prior prospective study, 25 but less than the rate of 21% reported in a retrospective study.…”

“…25 The 9% rate of solid organ injuries in those with seat belt signs was identical to that in the prior prospective study, 25 but less than the rate of 21% reported in a retrospective study. 24 Overall, the seat belt sign was associated with an increased risk of intra-abdominal injuries in our population, especially due to gastrointestinal injuries, which has previously been demonstrated and described. 25,31 Another study, however, suggested that the seat belt sign was not associated with abdominal injuries.…”

“…34,35 The laparotomy rate of 6% in the study population with seat belt signs was lower than the rate reported in most prior pediatric reports, ranging from 19% to 37%. 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.…”

“…Pediatric studies of this topic primarily consist of case series or retrospective reviews. [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] A single-center prospective study demonstrated an association between the seat belt sign and intra-abdominal injury in children, but was limited by its small sample size. 25 In contrast, one pediatric study failed to demonstrate any association between the seat belt sign and intra-abdominal injury.…”

Blunt abdominal trauma in children

“…It may be seen in children wearing an improperly fitted seat belt that crosses the abdomen instead of the pelvis. In addition to abdominal wall bruising, the 'seat belt syndrome' also includes vertebral Chance fractures resulting from the flexion-distraction injury of the spine at the fixed fulcrum site of the lap belt, and abdominal injuries from compression of intra-abdominal organs between the seat belt and the bony vertebral column [4]. A porcine animal model of seat belt related injuries demonstrated that direct compression of the specific organ under the seat belt was the mechanism causing the injuries, because the solid organ injuries were only generated with belt loading in the upper abdomen, whereas hollow viscus organ and bladder injuries were associated with lower abdomen belt loading [5].…”