Low probability of Significant Intra-Abdominal Injury in Stable Patients with Abdominal ‘‘Seat Belt Sign’’

Makrin, Vadim; Wiesel, Ory; Heller, Daniel B.; Klausner, Joseph M.; Soffer, Dror

doi:10.1007/s00068-008-8161-2

Cited by 8 publications

(5 citation statements)

References 18 publications

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“…Furthermore, not all patients with IAI have AWE 6,8,10,23 and some studies report no increased risk of IAI in patients with AWE. 24,25 In this study, 22% of patients with IAI had no AWE noted in their chart. TLICS can be a valuable tool in patients without AWE to indicate risk of concomitant IAI; however, even in patients with AWEs, this study demonstrates that combining TLICS and AWE is a stronger predictor of concomitant IAI than AWE alone.…”

Section: Discussionmentioning

confidence: 57%

“…While a physical exam may reveal concerning signs, children with IAI caused by blunt trauma, especially hollow viscous injuries, may have subtle, equivocal, or absent physical exam findings. 6,8,[23][24][25] Furthermore, if the patient has significant associated traumatic head injury and neurologic compromise, clinical examination and feedback may be limited. FAST (Focused Assessment with Sonography in Trauma) exams have shown to have mixed utility in identifying solid organ injury, are unable to identify hollow viscous injuries, and are not consistently used in the pediatric population.…”

Section: Discussionmentioning

confidence: 99%

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Thoracolumbar Injury Classification and Severity Scale Can Help Identify Intra-Abdominal Injury in Children Injured in an MVC

Sborov¹,

Vittetoe²,

Benvenuti³

et al. 2023

Journal of the Pediatric Orthopaedic Society of North America

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Background: Motor vehicle crashes (MVC) cause variable injury to the thoracolumbar (TL) region of children secondary to rapid deceleration from seatbelts. This mechanism can also predispose a child to intraabdominal injury (IAI), which necessitates early diagnosis to limit morbidity and mortality. While the maximum extent of TL spine injury can be appreciated shortly after presentation, the severity of IAI may not be appreciated until days later. It is hypothesized that a measure of TL-injury severity will identify patients at risk of concomitant IAI. Methods:Retrospective chart review identified 72 children with MVC-related TL spine injuries from 2007-2020. Patients were grouped based on the presence of IAI and TL spine injury (N=33) compared to isolated TL spine injury (no IAI, N=39). TL spine injury severity was classified according to the Thoracolumbar Injury Classification and Severity Scale (TLICS).Results: Demographics were similar in both groups. Children with concomitant IAI had primarily lumbar spine injuries, while injuries without associated IAI were more broadly distributed throughout the thoracolumbar spine. Children without concomitant IAI were more likely to sustain compression fractures (n=31, 79%), while children with

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Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Thoracolumbar Injury Classification and Severity Scale Can Help Identify Intra-Abdominal Injury in Children Injured in an MVC

Sborov¹,

Vittetoe²,

Benvenuti³

et al. 2023

Journal of the Pediatric Orthopaedic Society of North America

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“…In another large multicenter prospective study, SBS has been confirmed to be independently associated with intraabdominal injuries (5). On the other hand, a few reports revealed that SBS is not significantly associated with higher risk of intestinal injury (10,11). However, it should be kept in mind that SBS causes direct trauma to the abdominal wall muscles which may be seen concurrently with intra-abdominal injuries.…”

Section: Discussionmentioning

confidence: 94%

Emniyet Kemeri Yaralanmasında Görülen Bağırsak Avülsiyonu Tanısında Bilgisayarlı Tomografi Kullanımı: Olgu Sunumu

Boybeyi¹

2019

Turkish Journal of Pediatric Disease

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Seat-belt sign (SBS) is the pattern of thoraco-abdominal ecchymosis in distribution of seat-belt and considered to be strongly associated with intestinal injuries. Herein, an 11-year-old boy who had bowel avulsion was presented to discuss the use of computed tomography (CT) in the diagnosis of seat-belt injury in children. An 11-year-old boy was brought to the emergency room because of high-speed motor vehicle crash. His general condition was good. He had mild abdominal tenderness and a seat-belt bruising on his belly. The first laboratory examinations, chest and abdominal X-rays revealed normal findings. Abdominal ultrasound showed minimal free fluid. Since physical examination revealed ongoing tenderness, CT was performed. A large defect in abdominal fascia and disruption in sigmoid colon integrity were detected in CT. The patient underwent emergent exploration revealing disruption in fascia and avulsion in small and large intestine. The postoperative course was uneventful. Seat-belt injury is a rare type of pediatric trauma and may cause severe bowel injury. The diagnosis of bowel avulsion due to seat-belt injury can be challenging in the absence of free sub-diaphragmatic air in abdominal X-rays. CT should be performed if other radiologic interventions are not compatible with the physical findings.

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“…Doersch and Dozier described a characteristic compression scar as a sign to suspect seat belt syndrome, and called it the “SBS” 7 . SBS refers to subcutaneous hemorrhagic spots consistent with the belt site and is associated with intra-abdominal organ damage 17 , although there may be no associated injury even when SBS is present 18 . Johnson and Eastridge reported that if the SBS is superior to the ASIS, there is an increased risk of intra-abdominal injury and abdominal surgery, and if the SBS is inferior to the ASIS, there is an increased risk of pelvic fracture, which is an indication and predictor of abdominal surgery 19 .…”

Section: Discussionmentioning

confidence: 99%

A radiographic and physical analysis of factors affecting seat belt position in sitting car seat

Yamagata

Nishida

Izumiyama

et al. 2022

Sci Rep

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The characteristic subcutaneous hemorrhage along the seat belt in motor vehicle accidents is called the seat belt sign (SBS). The risk of organ injuries is especially high when abdominal SBS is located above the anterior superior iliac spine (ASIS). The purpose of this study analyzed the physical and radiographic factors of healthy volunteers sit on car seat that affect initial position of abdominal seat belt, namely “lap belt”, related to the seat belt injury. This study was examined prospectively relation between physical characteristics of one hundred healthy volunteers and lap belt position sitting the car seat. Physical findings were clarified age, sex, height, body mass index (BMI), and waist circumference. Radiographical findings were measured lumber lordosis (LL), sacral slope (SS), and initial lap belt position by marking with lead tape for the center and ASIS of the lap belt installed on the driver’s car seat. In the lateral X-ray image, we measured the horizontal distance (X-value) and vertical distance (Z-value) from the ASIS to the central marker. The lap belt angle was determined to measure the angle between the horizontal line and the straight line connecting the upper edges of the markers. Statistical analysis of the relationships between physical characteristics and radiological findings was performed. X-value and Z-value were positively correlated with body weight, BMI, and waist circumference, while the lap belt angle was negatively correlated with body weight, BMI, and waist circumference. The relationship between physical characteristics and the initial position of seat belt was analyzed. Since the lap belt is positioned higher than the ASIS in occupants with a high BMI, it is likely to cause seat belt injury. This analysis can help to develop safer seat belts and to enlighten car occupants.

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Low probability of Significant Intra-Abdominal Injury in Stable Patients with Abdominal ‘‘Seat Belt Sign’’

Abstract: Despite the widely accepted view that patients with an abdominal seat belt sign are more likely to have serious intraabdominal injuries, the results of our investigation showed no such association in a group of hemodynamically stable patients.

Cited by 8 publications

References 18 publications

Thoracolumbar Injury Classification and Severity Scale Can Help Identify Intra-Abdominal Injury in Children Injured in an MVC

Thoracolumbar Injury Classification and Severity Scale Can Help Identify Intra-Abdominal Injury in Children Injured in an MVC

Emniyet Kemeri Yaralanmasında Görülen Bağırsak Avülsiyonu Tanısında Bilgisayarlı Tomografi Kullanımı: Olgu Sunumu

A radiographic and physical analysis of factors affecting seat belt position in sitting car seat

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