Clinical Significance of the Seat Belt Sign as Evidence of a Compromised Occupant–Seat Belt Relationship

Greenston, Mathew; Wood, Rawson L.; Reinhart, Lars

doi:10.1016/j.jemermed.2019.01.035

Cited by 9 publications

(8 citation statements)

References 58 publications

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“…Although the frequency of mild injuries to the face or extremities has increased with the use of airbags, the forces to the abdomen have decreased by the distribution of blunt force energy away from the abdomen [21][22][23][24]. The purpose of a restraint system is to gradually decelerate the occupant over a longer period of time as well as distribute collision forces over a larger portion of the bony skeleton [25]. Therefore, airbag deployment in conjunction with correct seatbelt use can protect against severe abdominal injuries.…”

Section: Discussionmentioning

confidence: 99%

Predictive Factors of Severe Abdominal Injuries Due to Seatbelt Compression in Motor Vehicle Passengers

Ikegami

Hitosugi

Takashima

et al. 2022

Preprint

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The data set of the National Automotive Sampling System/Crashworthiness Data System was retrospectively analyzed to clarify the pattern and severity of seatbelt-induced abdominal injuries and determine the predictive factors of severe abdominal injuries. Among data of collisions that occurred from 1995 to 2011, we chose front-seat passengers with a height of >140 cm who developed seatbelt-induced abdominal injuries with an Abbreviated Injury Scale score of ≥2 during a frontal collision. The study population comprised 79 persons (24 male, 55 female; mean age, 37.5 years) with 136 abdominal injuries. Spleen, kidney, and liver injuries were the three most common seatbelt-induced injuries. The spleen was the most commonly injured site in both the moderate and severe injury groups. The liver was the second most commonly injured site in the moderate injury group, but no liver injuries occurred in the severe injury group (p = 0.001). The multivariable logistic regression analysis revealed that force to the lower abdomen positively influenced the occurrence of severe injuries and that airbag deployment negatively influenced the occurrence of severe injuries. Correct seatbelt use and airbag deployment can prevent severe seatbelt-induced abdominal injuries. Physicians should still suspect moderate abdominal injuries even in correctly restrained vehicle passengers.

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Section: Discussionmentioning

confidence: 99%

Predictive Factors of Severe Abdominal Injuries Due to Seatbelt Compression in Motor Vehicle Passengers

Ikegami

Hitosugi

Takashima

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…When positioned correctly, the abdominal portion lies across the upper anterior pelvis below the level of the anterior superior iliac spines. 2,3 Additional safety modifications have been integrated into restraint system design including pretensioners and load limiters which have significantly reduced excessive load being applied to an occupant's body on deceleration.…”

Section: Introductionmentioning

confidence: 99%

“…Seat belts can, however, cause occupant injury ranging from minor linear intra-dermal abrasions or contusions underneath the overlying belt to the fracturing of the sternum and ribs, injury to abdominal and thoracic organs, vascular transaction and fracturing of the lumbosacral spine (the so-called Chance fracture). [2][3][4][5][6] Previous research has shown an association between cutaneous seat belt markings and the presence of underlying internal, particularly abdominal injury. 2,3,[7][8][9][10] The current study aims to investigate the type of injuries that are associated with the use of seat belts, and if the presence of cutaneous seat belt markings can be used as a marker for internal injury in occupant fatalities.…”

Section: Introductionmentioning

confidence: 99%

Seat belt injuries and external markings at autopsy in cases of lethal vehicle crashes

et al. 2022

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A study was undertaken to determine what injuries are associated with the wearing of seat belts and if the presence of cutaneous seat belt markings observed on victims of lethal vehicle crashes increased the likelihood of underlying injury. Autopsy reports from the files at Forensic Science South Australia were reviewed for all fatal motor vehicle crashes from January 2014 to December 2018. A total of 173 cases were included for analysis with 127 occupants wearing seat belts at the time of impact (73.4%) (age range = 18–93; mean = 45 M:F = 81:46). Of these, only 38 had external seat belt markings (29.9%) (age range = 19–83; mean = 49 M:F = 20:18). Logistic regression modelling showed that occupants who were wearing seat belts were more likely to experience closed head injury without skull fractures in addition to mesenteric and gastrointestinal injury. Increasing body mass index increased the incidence of seat belt markings ( p < 0.01) and markings were more likely to be found in the presence of bilateral pelvic fractures. Thus, external seat belt markings were observed in only a minority of seatbelt wearers, and more often in individuals with higher BMIs and with bilateral pelvic fractures (possibly associated with greater momentum and impact force).

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“…Seat belts are designed to produce a more gradual deceleration of vehicle occupants and to distribute collision forces more evenly in addition to preventing ejection from a vehicle and impact with the steering wheel or dashboard. 1,2 Their use has clearly reduced both morbidity and mortality from vehicle crashes by an estimated 25%–53%, with more than 50,000 lives saved in the UK alone since mandatory wearing was legislated. 3,4 Occasional situations occur, however, where seat belts have resulted in either death or injuries involving vascular, abdominal, thoracic and spinal trauma.…”

Section: Introductionmentioning

confidence: 99%

“…5,6 This is most likely to occur if seat belts have not been properly positioned, resulting in a ‘compromised occupant–seat belt relationship’. 1…”

Section: Introductionmentioning

confidence: 99%

Lethal mechanisms in cases of inverted suspension from the lap component of seat belts

et al. 2021

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A retrospective review of autopsy files at Forensic Science South Australia in Adelaide, Australia, was undertaken over a five-year period from January 2014 to December 2018 for all motor vehicle crashes with rollovers ending with the vehicle inverted and the occupants suspended by the lap component of their seat belts. There were five cases, all male drivers (aged 18–67 years; Mage = 32 years). Acute neck flexion or head wedging was noted in four cases, with facial petechiae in four and facial congestion in one. Deaths were due to positional asphyxia in four cases, with the combined effects of positional asphyxia and head trauma accounting for the remaining case. Although all drivers had evidence of head impact which may have caused incapacitation, in only one case was this considered severe enough to have contributed to death. A blood alcohol level above the legal limit for driving was detected in two cases, but no other drugs were detected. This series demonstrates another subset of cases of seat belt–associated deaths where suspension upside down by the lap component of a seat belt had occurred after vehicle rollovers. Predisposing factors include incapacitation of the victim and delay in rescue. The postulated lethal mechanism involved respiratory compromise from the weight of abdominal viscera on the diaphragm, as well as upper airway compromise due to kinking of the neck and wedging of the head.

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Clinical Significance of the Seat Belt Sign as Evidence of a Compromised Occupant–Seat Belt Relationship

Cited by 9 publications

References 58 publications

Predictive Factors of Severe Abdominal Injuries Due to Seatbelt Compression in Motor Vehicle Passengers

Predictive Factors of Severe Abdominal Injuries Due to Seatbelt Compression in Motor Vehicle Passengers

Seat belt injuries and external markings at autopsy in cases of lethal vehicle crashes

Lethal mechanisms in cases of inverted suspension from the lap component of seat belts

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