“…Unintentional injury is the predominant cause of death among children aged 1–19 years in the United States, with MVAs being the most frequent etiology [ 15 ]. While widespread use of safety restraints for motor vehicle passengers has contributed to a 41% decrease in death rates over time [ 15 ], the so-called “seatbelt sign” where bruising is present over the chest and abdomen in the distribution of a safety belt has been associated with blunt abdominal trauma and injury to abdominal organs, inclusive of hollow viscera [ 16 , 17 , 18 ]. Pediatric blunt trauma accounts for 80–90% of pediatric abdominal injuries [ 7 ] and is most frequently associated with MVAs, but other mechanisms have been well described, such as injury secondary to bicycles, the so-called “handlebar injury”, falls onto blunt objects, sports and non-accidental trauma [ 3 , 19 , 20 , 21 ].…”