The use of computed tomography imaging for abdominal seatbelt sign: A single-center, prospective evaluation

Delaplain, Patrick T.; Barrios, Cristobal; Spencer, Dean; Lekawa, Michael; Schubl, Sebastian; Dosch, Austin R.; Grigorian, Areg; Smith, Megan M.; Pejcinovska, Marija; Nahmias, Jeffry

doi:10.1016/j.injury.2019.10.089

Cited by 14 publications

(14 citation statements)

References 16 publications

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“…The prospective design of this study was similar to the single-institution studies published by many of us and shares a similar finding: Operative HVI is exceedingly low, if not zero, in the presence of a normal CT . Free fluid remained the most common finding in patients with HVI, occurring in nearly 90% of patients.…”

Section: Discussionmentioning

confidence: 48%

“…Free fluid remained the most common finding in patients with HVI, occurring in nearly 90% of patients. Our prior prospective study had 1 patient whose only finding on CT was an abdominal wall contusion, which was not replicated in this study.…”

Section: Discussionmentioning

confidence: 62%

“…The practice of admitting patients with abdominal SBS has persisted despite its origin dating to when CT technology was less sophisticated. Over the last 5 years, 3 single-institution studies that included 841 patients have examined abdominal SBS and found no instances of missed HVI . The current study sought to improve on previous studies by providing a prospective evaluation of abdominal SBS across 9 trauma centers.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, the high incidence of HVI with abdominal SBS reported in prior studies may have been related to differences in safety between 2-point and modern 3-point restraints. Regardless, multiple studies have challenged the notion of limitations of CT in blunt abdominal trauma and abdominal SBS, each showing an HVI detection rate of nearly 100% . However, these findings have been limited to single-institution studies.…”

Section: Introductionmentioning

confidence: 99%

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Excluding Hollow Viscus Injury for Abdominal Seat Belt Sign Using Computed Tomography

et al. 2022

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Abdominal seat belt sign (SBS) has historically entailed admission and observation because of the diagnostic limitations of computed tomography (CT) imaging and high rates of hollow viscus injury (HVI). Recent single-institution, observational studies have questioned the utility of this practice.OBJECTIVE To evaluate whether a negative CT scan can safely predict the absence of HVI in the setting of an abdominal SBS. DESIGN, SETTING, AND PARTICIPANTSThis prospective, observational cohort study was conducted in 9 level I trauma centers between August 2020 and October 2021 and included adult trauma patients with abdominal SBS.EXPOSURES Inclusion in the study required abdominal CT as part of the initial trauma evaluation and before any surgical intervention, if performed. Results of CT scans were considered positive if they revealed any of the following: abdominal wall soft tissue contusion, free fluid, bowel wall thickening, mesenteric stranding, mesenteric hematoma, bowel dilation, pneumatosis, or pneumoperitoneum. MAIN OUTCOMES AND MEASURES Presence of HVI diagnosed at the time of operative intervention.RESULTS A total of 754 patients with abdominal SBS had an HVI prevalence of 9.2% (n = 69), with only 1 patient with HVI (0.1%) having a negative CT (ie, none of the 8 a priori CT findings). On bivariate analysis comparing patients with and without HVI, there were significant associations between each of the individual CT scan findings and the presence of HVI. The strongest association was found with the presence of free fluid, with a more than 40-fold increase in the likelihood of HVI (odds ratio [OR], 42.68; 95% CI, 20.48-88.94; P < .001). The presence of free fluid also served as the most effective binary classifier for presence of HVI (area under the receiver operator characteristic curve [AUC], 0.87; 95% CI, 0.83-0.91). There was also an association between a negative CT scan and the absence of HVI (OR, 41.09; 95% CI, 9.01-727.69; P < .001; AUC, 0.68; 95% CI, 0.66-0.70). CONCLUSIONS AND RELEVANCEThe prevalence of HVI among patients with an abdominal SBS and negative findings on CT is extremely low, if not zero. The practice of admitting and observing all patients with abdominal SBS should be reconsidered when a high-quality CT scan is negative, which may lead to significant resource and cost savings.

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Section: Discussionmentioning

confidence: 48%

Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Excluding Hollow Viscus Injury for Abdominal Seat Belt Sign Using Computed Tomography

et al. 2022

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“…The most common injuries identified intraoperatively in patients with seatbelt sign involve small bowel (58%), large bowel (39%), and the spleen (39%) [ 14 ]. Seatbelt sign should prompt definitive imaging with CT scan and the subgroup of patients with negative CT scan should be admitted for serial examination [ 14 , 15 ]. Those patients with a positive CT and seatbelt sign should be evaluated for operative or non-operative management.…”

Section: Blunt Abdominal Trauma: Observation and Nonoperative Managementmentioning

confidence: 99%

WSES guidelines on blunt and penetrating bowel injury: diagnosis, investigations, and treatment

et al. 2022

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The aim of this paper was to review the recent literature to create recommendations for the day-to-day diagnosis and surgical management of small bowel and colon injuries. Where knowledge gaps were identified, expert consensus was pursued during the 8th International Congress of the World Society of Emergency Surgery Annual (September 2021, Edinburgh). This process also aimed to guide future research.

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Improved Computed Tomography Performance in Blunt Abdominal Trauma—Has Our Care Kept Pace?

2022

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The use of computed tomography imaging for abdominal seatbelt sign: A single-center, prospective evaluation

Cited by 14 publications

References 16 publications

Excluding Hollow Viscus Injury for Abdominal Seat Belt Sign Using Computed Tomography

Excluding Hollow Viscus Injury for Abdominal Seat Belt Sign Using Computed Tomography

WSES guidelines on blunt and penetrating bowel injury: diagnosis, investigations, and treatment

Improved Computed Tomography Performance in Blunt Abdominal Trauma—Has Our Care Kept Pace?

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