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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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O'Donovan S, van den Heuvel C, Baldock M, Humphries MA, Byard RW. Seat belt injuries and external markings at autopsy in cases of lethal vehicle crashes. MEDICINE, SCIENCE, AND THE LAW 2023; 63:195-202. [PMID: 36198036 DOI: 10.1177/00258024221127845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A study was undertaken to determine what injuries are associated with the wearing of seat belts and if the presence of cutaneous seat belt markings observed on victims of lethal vehicle crashes increased the likelihood of underlying injury. Autopsy reports from the files at Forensic Science South Australia were reviewed for all fatal motor vehicle crashes from January 2014 to December 2018. A total of 173 cases were included for analysis with 127 occupants wearing seat belts at the time of impact (73.4%) (age range = 18-93; mean = 45 M:F = 81:46). Of these, only 38 had external seat belt markings (29.9%) (age range = 19-83; mean = 49 M:F = 20:18). Logistic regression modelling showed that occupants who were wearing seat belts were more likely to experience closed head injury without skull fractures in addition to mesenteric and gastrointestinal injury. Increasing body mass index increased the incidence of seat belt markings (p < 0.01) and markings were more likely to be found in the presence of bilateral pelvic fractures. Thus, external seat belt markings were observed in only a minority of seatbelt wearers, and more often in individuals with higher BMIs and with bilateral pelvic fractures (possibly associated with greater momentum and impact force).
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Affiliation(s)
- Siobhan O'Donovan
- School of Biomedicine, The University of Adelaide, SA, Australia
- Forensic Science SA, Adelaide, SA, Australia
| | | | - Matthew Baldock
- Centre for Automotive Safety Research, The University of Adelaide, SA, Australia
| | | | - Roger W Byard
- School of Biomedicine, The University of Adelaide, SA, Australia
- Forensic Science SA, Adelaide, SA, Australia
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Abid M, Schneider A, Raff L, Charles A, Gallaher JR. Validating the danger of vehicular protective devices and bowel injury. Injury 2022; 53:3047-3051. [PMID: 35613968 DOI: 10.1016/j.injury.2022.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/06/2022] [Accepted: 04/29/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Protective devices such as seat belts and airbags have improved the safety of motor vehicle occupants, but limited data suggest they may be associated with increased blunt bowel (small bowel or colon) injuries (BI). Unfortunately, this risk is unquantified. METHODS We analyzed the National Trauma Data Bank (2017-2019) using ICD-10 codes to identify adult motor vehicle occupants with BI who underwent surgical repair. We used logistic regression modeling to compare the risk of undergoing surgical repair for BI after using a protective device. RESULTS Of 2,848,592 injured patients, 475,546 (16.7%) were motor vehicle occupants. Only 1.2% (n = 5627/475,546) of patients underwent a bowel repair or resection. Using a seat belt only was associated with an adjusted OR of 2.09 (95% CI 1.91, 2.28) for undergoing a bowel repair/resection when adjusting for Injury Severity Score (ISS) and age. Airbag deployment without a seat belt had an adjusted OR of 1.46 (95% CI 1.31, 1.62), while both devices combined conferred an OR of 3.27 (95% CI 3.02, 3.54). However, using a seat belt was protective against death with an OR of 0.50 (95% CI 0.48, 0.53), adjusted for age, sex, Charlson Comorbidity Score, and ISS. CONCLUSION Seat belts and airbags are essential public health safety interventions and protect against death in motor vehicle-associated injuries. However, patients involved in MVCs with airbag deployment or while wearing a seat belt are at an increased risk of bowel injury requiring surgery compared to unrestrained patients, despite these events being relatively uncommon.
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Affiliation(s)
- Mustafa Abid
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of North Carolina at Chapel Hill, NC
| | - Andrew Schneider
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of North Carolina at Chapel Hill, NC
| | - Lauren Raff
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of North Carolina at Chapel Hill, NC
| | - Anthony Charles
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of North Carolina at Chapel Hill, NC
| | - Jared R Gallaher
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of North Carolina at Chapel Hill, NC.
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Esmaili N, Buchlak QD, Piccardi M, Kruger B, Girosi F. Multichannel mixture models for time-series analysis and classification of engagement with multiple health services: An application to psychology and physiotherapy utilization patterns after traffic accidents. Artif Intell Med 2020; 111:101997. [PMID: 33461690 DOI: 10.1016/j.artmed.2020.101997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 10/02/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Motor vehicle accidents (MVA) represent a significant burden on health systems globally. Tens of thousands of people are injured in Australia every year and may experience significant disability. Associated economic costs are substantial. There is little literature on the health service utilization patterns of MVA patients. To fill this gap, this study has been designed to investigate temporal patterns of psychology and physiotherapy service utilization following transport-related injuries. METHOD De-identified compensation data was provided by the Australian Transport Accident Commission. Utilization of physiotherapy and psychology services was analysed. The datasets contained 788 psychology and 3115 physiotherapy claimants and 22,522 and 118,453 episodes of service utilization, respectively. 582 claimants used both services, and their data were preprocessed to generate multidimensional time series. Time series clustering was applied using a mixture of hidden Markov models to identify the main distinct patterns of service utilization. Combinations of hidden states and clusters were evaluated and optimized using the Bayesian information criterion and interpretability. Cluster membership was further investigated using static covariates and multinomial logistic regression, and classified using high-performing classifiers (extreme gradient boosting machine, random forest and support vector machine) with 5-fold cross-validation. RESULTS Four clusters of claimants were obtained from the clustering of the time series of service utilization. Service volumes and costs increased progressively from clusters 1 to 4. Membership of cluster 1 was positively associated with nerve damage and negatively associated with severe ABI and spinal injuries. Cluster 3 was positively associated with severe ABI, brain/head injury and psychiatric injury. Cluster 4 was positively associated with internal injuries. The classifiers were capable of classifying cluster membership with moderate to strong performance (AUC: 0.62-0.96). CONCLUSION The available time series of post-accident psychology and physiotherapy service utilization were coalesced into four clusters that were clearly distinct in terms of patterns of utilization. In addition, pre-treatment covariates allowed prediction of a claimant's post-accident service utilization with reasonable accuracy. Such results can be useful for a range of decision-making processes, including the design of interventions aimed at improving claimant care and recovery.
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Affiliation(s)
- Nazanin Esmaili
- Faculty of Engineering and IT, University of Technology Sydney, NSW, Australia; School of Medicine, University of Notre Dame Australia, Sydney, NSW, Australia.
| | - Quinlan D Buchlak
- School of Medicine, University of Notre Dame Australia, Sydney, NSW, Australia
| | - Massimo Piccardi
- Faculty of Engineering and IT, University of Technology Sydney, NSW, Australia
| | - Bernie Kruger
- Transport Accident Commission, Geelong, VIC, Australia
| | - Federico Girosi
- Capital Markets Cooperative Research Centre (CMCRC), Sydney, NSW, Australia; Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
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Shreffler J, Smiley A, Schultz M, Ross A, Baker J, Nash N, Harbrecht B, Huecker M. Patients with Abrasion or Ecchymosis Seat Belt Sign Have High Risk for Abdominal Injury, but Initial Computed Tomography is 100% Sensitive. J Emerg Med 2020; 59:491-498. [PMID: 32826121 DOI: 10.1016/j.jemermed.2020.06.057] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 05/25/2020] [Accepted: 06/11/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Trauma providers seek to accurately assess the risk of patients with abdominal seat belt sign (ASBS). As hospital costs continue to rise, identification of strategies to safely discharge emergency department (ED) patients has become crucial. OBJECTIVES The purpose of this study is to 1) describe a large cohort of patients by type of ASBS and 2) determine the value of computed tomography (CT) of the abdomen and pelvis as a screening tool to rule out intra-abdominal injury (IAI) and support discharge of stable patients. METHODS We conducted a retrospective case series of all patients presenting to our urban, Level I trauma center from 2013-2015. We studied motor vehicle collision patients who presented with ASBS. We further classified individuals into ASBS groups: Abrasion, Ecchymosis, Abrasion + Ecchymosis, or Unknown ASBS to examine differences between groups. RESULTS In one of the largest described cohorts, the ASBS remained associated with IAI, most commonly, solid organ injury. Of 425 patients, 36.1% had some IAI on CT, but only 13.6% required laparotomy. Categorizing the type of skin injury in ASBS, we found that both abrasion and ecchymosis were associated with IAI. Initial CT performed with 100% sensitivity. CONCLUSIONS This study shows that ED trauma patients with significant seat belt abrasion or contusion can have IAI. With the very high sensitivity of modern abdominal CT scanners, clinicians could consider safe ED discharge of stable ASBS patients while providing strong return precautions. Our large cohort strengthens the evidence on decision-making in ASBS patients to ensure outcomes and use of health care resources.
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Affiliation(s)
- Jacob Shreffler
- Department of Emergency Medicine, University of Louisville, Louisville, Kentucky
| | - Abbey Smiley
- Department of Undergraduate Medical Education, University of Louisville, Louisville, Kentucky
| | - Melissa Schultz
- Department of Emergency Medicine, University of Louisville, Louisville, Kentucky
| | - Adam Ross
- Department of Emergency Medicine, University of Louisville, Louisville, Kentucky
| | - Jeffery Baker
- Department of Emergency Medicine, University of Louisville, Louisville, Kentucky
| | - Nicholas Nash
- Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Brian Harbrecht
- Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Martin Huecker
- Department of Emergency Medicine, University of Louisville, Louisville, Kentucky
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Herath M, Bautz P, Parker D, Dobbins C. The importance of wearing a seatbelt correctly - A case report of blunt trauma causing complete shearing transection of the gastroduodenal junction. Int J Surg Case Rep 2020; 72:197-201. [PMID: 32544828 PMCID: PMC7298554 DOI: 10.1016/j.ijscr.2020.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/02/2020] [Accepted: 05/02/2020] [Indexed: 11/25/2022] Open
Abstract
Seat belt related injuries can cause significant morbidity and mortality in road traffic accidents. We present a case where an improperly worn seatbelt caused traumatic shearing transection of the gastroduodenal junction. A systematic multidisciplinary assessment approach enabled all injuries to be identified early. The patient underwent damage control exploratory laparotomy then delayed reconstruction of the alimentary tract.
Introduction Global mortality as a result of road traffic accidents (RTA) has reduced significantly since mandatory implementation of seatbelts. Whilst seatbelt related injury, or “seatbelt syndrome,” is a recognised phenomenon, unrestrained passengers have considerably worse survival outcomes. Improper positioning of seatbelts, as is discussed in the following case, can cause extensive injury. Presentation of case Our patient is a 35-year-old female who was a restrained front seat passenger in a car vs. tree collision at 80 km/h. Her seat belt was worn with the shoulder strap under her left axilla. She sustained multiple injuries including complete transection of the gastroduodenal junction. In addition to this she had splenic, liver, transverse colonic, left lower rib and humeral injury. She underwent damage control laparotomy with splenectomy; re-look with gastrojejunostomy and transverse colonic resection with defunctioning ileostomy. She made a good recovery and was discharged after a 4 week admission. Discussion Improperly worn seatbelts redistribute decelerative forces to sensitive regions. A multidisciplinary approach is required to effectively manage complex multi-system trauma. In trauma the simplest reconstructive measures can be the most effective and minimise risk of further complications for the patient. Conclusion Improperly worn seatbelts pose a significant risk to patients. A traumatic complete gastroduodenal transection can be effectively reconstructed with gastrojejunostomy anastomosis.
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Affiliation(s)
- Matheesha Herath
- The Royal Adelaide Hospital, Port Road, Adelaide, South Australia, 5000, Australia.
| | - Peter Bautz
- The Royal Adelaide Hospital, Port Road, Adelaide, South Australia, 5000, Australia
| | - Dominic Parker
- The Royal Adelaide Hospital, Port Road, Adelaide, South Australia, 5000, Australia
| | - Christopher Dobbins
- The Royal Adelaide Hospital, Port Road, Adelaide, South Australia, 5000, Australia
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Positive Seatbelt Sign with Avulsed Leiomyoma following Motor Vehicle Accident Leading to Hemoperitoneum. Case Rep Emerg Med 2018; 2018:4251408. [PMID: 30225150 PMCID: PMC6129369 DOI: 10.1155/2018/4251408] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/12/2018] [Indexed: 11/18/2022] Open
Abstract
A positive seatbelt sign following a motor vehicle accident is associated with an increased risk of intra-abdominal injury and hemoperitoneum. Injury to the uterus in reproductive-age women can also occur. In this report, we describe a 29-year-old nulligravida female who presented to the emergency room following a motor vehicle accident at freeway speeds. A positive seatbelt sign was noted, and a focused assessment with sonography for trauma revealed hemoperitoneum with an incidental finding of uterine leiomyomata. Upon exploratory laparotomy, a free-floating intraperitoneal mass was identified as an avulsed uterine leiomyoma. A uterine laceration containing a subserosal leiomyoma was also identified. The gynecological team was consulted, and a myomectomy of the subserosal leiomyoma followed by a closure of the uterine laceration was performed. The patient was transfused with a total of three units of packed red blood cells and two units of fresh frozen plasma. The postoperative course was without major complication. A positive seatbelt sign and hemoperitoneum in a reproductive-age woman with leiomyomata should increase the clinical suspicion for uterine injury and decrease the threshold for obtaining a gynecological consultation.
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