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Pourmand A, Terrebonne E, Shapovalov V, Kartiko S, AlRemeithi R, Tran QK. Prevalence of intra-abdominal injury among patients with seatbelt signs, a systematic review and meta-analysis. Am J Emerg Med 2024; 76:199-206. [PMID: 38086186 DOI: 10.1016/j.ajem.2023.11.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/09/2023] [Accepted: 11/28/2023] [Indexed: 01/22/2024] Open
Abstract
INTRODUCTION The advancement of seat belts have been essential to reducing morbidity and mortality related to motor vehicle collisions (MVCs). The "seat belt sign" (SBS) is an important physical exam finding that has guided management for decades. This study, comprising a systematic review and random-effects meta-analysis, asses the current literature for the likelihood of the SBS relating to intra-abdominal injury and surgical intervention. METHODS PubMed and Scopus databases were searched from their beginnings through August 4, 2023 for eligible studies. Outcomes included the prevalence of intra-abdominal injury and need for surgical intervention. Cochrane's Risk of Bias (RoB) tool and the Newcastle-Ottawa Scale (NOS) were applied to assess risk of bias and study quality; Q-statistics and I2 values were used to assess for heterogeneity. RESULTS The search yielded nine observational studies involving 3050 patients, 1937 (63.5%) of which had a positive SBS. The pooled prevalence of any intra-abdominal injury was 0.42, (95% CI 0.28-0.58, I2 = 96%) The presence of a SBS was significantly associated with increased odds of intra-abdominal injury (OR 3.62, 95% CI 1.12-11.6, P = 0.03; I2 = 89%), and an increased likelihood of surgical intervention (OR 7.34, 95% CI 2.03-26.54, P < 0.001; I2 = 29%). The measurement for any intra-abdominal injury was associated with high heterogeneity, I2 = 89%. CONCLUSION This meta-analysis suggests that the presence of a SBS was associated with a statistically significant higher likelihood of intra-abdominal injury and need for surgical intervention. The study had high heterogeneity, likely due to the technological advancements over the course of this study, including seat belt design and diagnostic imaging sensitivity. Further studies with more recent data are needed to confirm these results.
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Affiliation(s)
- Ali Pourmand
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
| | - Emily Terrebonne
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Vadym Shapovalov
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Susan Kartiko
- Department of Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC, United States
| | - Rashed AlRemeithi
- Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Quincy K Tran
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States; Program in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, United States
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Santos J, Delaplain PT, Tay-Lasso E, Biffl WL, Schaffer KB, Sundel M, Ghneim M, Costantini TW, Santorelli JE, Switzer E, Schellenberg M, Keeley JA, Kim DY, Wang A, Dhillon NK, Patel D, Campion EM, Robinson CK, Kartiko S, Quintana MT, Estroff JM, Kirby KA, Grigorian A, Nahmias J. Development and Validation of a Novel Hollow Viscus Injury Prediction Score for Abdominal Seatbelt Sign: A Pacific Coast Surgical Association Multicenter Study. J Am Coll Surg 2023; 237:826-833. [PMID: 37703489 DOI: 10.1097/xcs.0000000000000863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
BACKGROUND High-quality CT can exclude hollow viscus injury (HVI) in patients with abdominal seatbelt sign (SBS) but performs poorly at identifying HVI. Delay in diagnosis of HVI has significant consequences necessitating timely identification. STUDY DESIGN This multicenter, prospective observational study conducted at 9 trauma centers between August 2020 and October 2021 included adult trauma patients with abdominal SBS who underwent abdominal CT before surgery. HVI was determined intraoperatively and physiologic, examination, laboratory, and imaging findings were collected. Least absolute shrinkage and selection operator- and probit regression-selected predictor variables and coefficients were used to assign integer points for the HVI score. Validation was performed by comparing the area under receiver operating curves (AUROC). RESULTS Analysis included 473 in the development set and 203 in the validation set. The HVI score includes initial systolic blood pressure <110 mmHg, abdominal tenderness, guarding, and select abdominal CT findings. The derivation set has an AUROC of 0.96, and the validation set has an AUROC of 0.91. The HVI score ranges from 0 to 17 with score 0 to 5 having an HVI risk of 0.03% to 5.36%, 6 to 9 having a risk of 10.65% to 44.1%, and 10 to 17 having a risk of 58.59% to 99.72%. CONCLUSIONS This multicenter study developed and validated a novel HVI score incorporating readily available physiologic, examination, and CT findings to risk stratify patients with an abdominal SBS. The HVI score can be used to guide decisions regarding management of a patient with an abdominal SBS and suspected HVI.
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Affiliation(s)
- Jeffrey Santos
- From the Division of Trauma, Burns, Critical Care & Acute Care Surgery, Department of Surgery, University of California, Irvine, Orange, CA (Santos, Delaplain, Tay-Lasso, Grigorian, Nahmias)
| | - Patrick T Delaplain
- From the Division of Trauma, Burns, Critical Care & Acute Care Surgery, Department of Surgery, University of California, Irvine, Orange, CA (Santos, Delaplain, Tay-Lasso, Grigorian, Nahmias)
- Department of Surgery, Boston Children's Hospital/Harvard Medical System, Boston, MA (Delaplain)
| | - Erika Tay-Lasso
- From the Division of Trauma, Burns, Critical Care & Acute Care Surgery, Department of Surgery, University of California, Irvine, Orange, CA (Santos, Delaplain, Tay-Lasso, Grigorian, Nahmias)
| | - Walter L Biffl
- Trauma Department, Scripps Memorial Hospital La Jolla, La Jolla, CA (Biffl, Schaffer)
| | - Kathryn B Schaffer
- Trauma Department, Scripps Memorial Hospital La Jolla, La Jolla, CA (Biffl, Schaffer)
| | - Margaret Sundel
- Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD (Sundel, Ghneim)
| | - Mira Ghneim
- Program in Trauma, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD (Sundel, Ghneim)
| | - Todd W Costantini
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, University of California San Diego School of Medicine, San Diego, CA (Costantini, Santorelli)
| | - Jarrett E Santorelli
- Division of Trauma, Surgical Critical Care, Burns and Acute Care Surgery, University of California San Diego School of Medicine, San Diego, CA (Costantini, Santorelli)
| | - Emily Switzer
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA (Switzer, Schellenberg)
| | - Morgan Schellenberg
- Division of Acute Care Surgery, LAC+USC Medical Center, University of Southern California, Los Angeles, CA (Switzer, Schellenberg)
| | - Jessica A Keeley
- Division of Trauma/Acute Care Surgery/Surgical Critical Care, Harbor-UCLA Medical Center, Torrance, CA (Keeley, Kim)
| | - Dennis Y Kim
- Division of Trauma/Acute Care Surgery/Surgical Critical Care, Harbor-UCLA Medical Center, Torrance, CA (Keeley, Kim)
| | - Andrew Wang
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA (Want, Dhillon, Patel)
| | - Navpreet K Dhillon
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA (Want, Dhillon, Patel)
| | - Deven Patel
- Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA (Want, Dhillon, Patel)
| | - Eric M Campion
- Department of Surgery, Denver Health Medical Center, Denver, CO (Campion, Robinson)
| | - Caitlin K Robinson
- Department of Surgery, Denver Health Medical Center, Denver, CO (Campion, Robinson)
| | - Susan Kartiko
- Department of Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC (Kartiko, Quintana, Estroff)
| | - Megan T Quintana
- Department of Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC (Kartiko, Quintana, Estroff)
| | - Jordan M Estroff
- Department of Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC (Kartiko, Quintana, Estroff)
| | - Katharine A Kirby
- Center for Statistical Consulting, Department of Statistics, University of California Irvine, Irvine, CA (Kirby)
| | - Areg Grigorian
- From the Division of Trauma, Burns, Critical Care & Acute Care Surgery, Department of Surgery, University of California, Irvine, Orange, CA (Santos, Delaplain, Tay-Lasso, Grigorian, Nahmias)
| | - Jeffry Nahmias
- From the Division of Trauma, Burns, Critical Care & Acute Care Surgery, Department of Surgery, University of California, Irvine, Orange, CA (Santos, Delaplain, Tay-Lasso, Grigorian, Nahmias)
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Cottey L, Wood F, Humphries C, Seden B, Peachey J, Clymer J, Barham F, Smith J. Journal update monthly top five. J Accid Emerg Med 2023; 40:79-80. [PMID: 36603892 DOI: 10.1136/emermed-2022-212993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 11/26/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Laura Cottey
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, Birmingham, UK .,The School of Biological Sciences, The University of Manchester, Manchester, UK
| | - Felix Wood
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, Birmingham, UK.,Emergency Department, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Christopher Humphries
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, Birmingham, UK
| | - Briony Seden
- Medical School, Keele University, Keele, Staffordshire, UK
| | | | - Joseph Clymer
- Faculty of Health, University of Plymouth, Plymouth, UK
| | - Ffion Barham
- Emergency Department, University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - Jason Smith
- Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Birmingham, Birmingham, UK
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