Safety-belt injuries in children with lap-belt ecchymosis: CT findings in 61 patients.

Sivit, Carlos J.; Taylor, George A.; Newman, Kenneth D.; Bulas, Dorothy; Gotschall, Catherine S.; Wright, Christopher; Eichelberger, Martin R.

doi:10.2214/ajr.157.1.2048507

Cited by 82 publications

(34 citation statements)

References 10 publications

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“…Although there have been unfavorable reports on the reliability of CT to detect GI perforation [8,9], our findings lend weight to the body of literature advocating the role of CT [5][6][7][10][11][12]. Our 10-year review of hospital records identified no surgically confirmed GI perforation with a normal CT study, and all the CT studies in our perforation patients were abnormal.…”

Section: Discussionsupporting

confidence: 54%

Imaging gastrointestinal perforation in pediatric blunt abdominal trauma

1996

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Section: Discussionsupporting

confidence: 54%

Imaging gastrointestinal perforation in pediatric blunt abdominal trauma

1996

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“…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.…”

Section: Discussionmentioning

confidence: 99%

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

Borgialli

Ellison

Ehrlich

et al. 2014

Academic Emergency Medicine

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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%;

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“…The majority of injuries are associated with isolated two-point lap belt use. However, a small number have been reported with the use of the three-point shoulder harness [1,2,3,4].…”

Section: Discussionmentioning

confidence: 99%

“…Sivit et al [3] found that of 61 children (age range 2±17 years) with the ªseat belt sign,º 22 (36 %) had an injury of the lumbar spine or hollow viscus, and 5 (8 %) had injuries to both. In a review of 84 cases of intra-abdominal injury in restrained passengers, flexion±distrac-tion injuries occurred in 21 %, and in 7 of the 9 (78 %) children [4].…”

Section: Discussionmentioning

confidence: 99%

“…The majority of injuries are associated with isolated two-point lap belt use. However, a small number have been reported with the use of the three-point shoulder harness [1,2,3,4].A unique ªtriadº of injuries has been attributed to the use of seat belts during motor vehicle collisions. This includes flexion±distraction (ªChance-likeº) injuries of the lumbar spine, intra-abdominal injuries, usually to bowel or mesentery, and the less commonly described injuries to the abdominal aorta [5,6,7].…”

mentioning

confidence: 99%

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Abdominal aortic injury associated with “seat belt syndrome”

Perry¹,

Escobedo²,

Mann³

2000

Emergency Radiology

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Flexion±distraction spinal injuries and intraabdominal visceral injuries have a well-recognized association with the use of passive restraints during motor vehicle collisions. Abdominal aortic injury due to blunt trauma is rare. However, there is a reported association of this injury with seat belt use. We report a case of a restrained passenger in a motor vehicle collision who sustained this triad of injuries, with the abdominal aortic injury not initially suspected.Key words seat belts ± spinal fractures ± aortic rupture ± abdominal injuries ± aorta ± aorta/abdominal Case reportA 21 year-old restrained male passenger was involved in a highspeed motor vehicle collision with a tree. He was alert but complained of upper abdominal and low back pain. Physical examination revealed shoulder and lap belt abrasions and ecchymosis across the chest and abdomen. Vital signs were stable, and peripheral pulses were reportedly normal. The abdomen was diffusely tender, with tense abdominal muscles. Neurologic examination was normal. Diagnostic peritoneal lavage (DPL) was grossly negative, but microscopic analysis revealed 155,000 red blood cells/ml and 700 white cells/ml.Conventional radiographs of the lumbar spine ( Fig. 1) obtained shortly after arrival showed a flexion±distraction injury at L1±L2.Because of the presence of abdominal symptoms and signs, a positive DPL, and a flexion±distraction spinal injury, an abdominal CT was obtained (Fig. 2). This showed marked focal small bowel dilatation and wall thickening in the left upper quadrant and midabdomen. There was an irregular circumferential filling defect in the infrarenal abdominal aorta and a large central retroperitoneal hematoma. Angiography (Fig. 3) obtained immediately afterwards confirmed the aortic injury seen on CT, showing circumferential dissection and pseudoaneurysm of the abdominal aorta at the level of the inferior mesenteric artery, midway between the renal arteries and the iliac bifurcation, with proximal and distal stenoses.Exploratory laparotomy was then performed and revealed perforation of the proximal jejunum with mesenteric hematoma and serosal injuries of the stomach, proximal jejunum, and distal transverse colon, as well as a slowly expanding central retroperitoneal hematoma. These injuries were repaired. No duodenal or pancreatic injury was found. Open repair of the pseudoaneurysm was contraindicated because of peritoneal contamination from bowel injury. Therefore, while the patient was in the operating room, a Wallstent was placed across the aortic defect by percutaneous endovascular technique. Because of continued filling of the pseudoaneurysm, an endovascular stent graft was placed 24 h later, with no further evidence of filling. The patient subsequently underwent open reduction and internal fixation of his spinal injury, and was later discharged in stable condition. DiscussionAlthough the value of passive restraints in preventing serious and life threatening injuries in vehicular collisions is unquestioned, injuries associated with their use ...

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Safety-belt injuries in children with lap-belt ecchymosis: CT findings in 61 patients.

Cited by 82 publications

References 10 publications

Imaging gastrointestinal perforation in pediatric blunt abdominal trauma

Imaging gastrointestinal perforation in pediatric blunt abdominal trauma

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

Abdominal aortic injury associated with “seat belt syndrome”

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