The seat-belt sign

Patients with Abrasion or Ecchymosis Seat Belt Sign Have High Risk for Abdominal Injury, but Initial Computed Tomography is 100% Sensitive

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.

The utility of seat belt signs to predict intra-abdominal injury following motor vehicle crashes

OBJECTIVE

Safety belts are the most important safety system in motor vehicles and should always be worn to prevent serious injury. The purpose of this study, using Crash Injury Research Engineering Network (CIREN) data, was to assess occupant and crash factors associated with minor contusions and abrasions caused by the safety belt (commonly referred to as seat belt signs) and their association with serious intra-abdominal trauma.

METHODS

CIREN data were used to determine which factors are associated with seat belt signs. Occupant variables (age, gender, body mass index, proper safety belt use, driver v. passenger status) and crash variables (crash type, crash severity, and airbag deployment) were compared for occupants with seat belt sign who had serious (AIS 3 or greater) intra-abdominal injury and those who did not have intra-abdominal injuries. Adjusted odds ratios were used to quantify the independent association between predictive factors for serious intra-abdominal injury for occupants with seat belt signs.

RESULTS

Of 1539 occupants included in this study, 419 had a positive seat belt signs. Of those 419 occupants, 100 had serious intra-abdominal injury and 319 did not. Being in the passenger seat position increased the odds, whereas front airbag deployment and frontal impact were associated with decreased odds of serious intra-abdominal injury for occupants with seat belt signs. However, multivariate analysis showed only that being a passenger increased the odds (OR = 2.64) of having serious intra-abdominal injury for occupants with seat belt signs when other factors, including crash severity and type of impact, were controlled for in the analysis.

CONCLUSIONS

Seat belt signs remain an important physical finding in patients with intra-abdominal injury following motor vehicle crashes. Front seat passengers presenting with seat belt signs were more than twice as likely to sustain intra-abdominal injury; thus, emergency physicians and trauma surgeons should be aware of passenger position when evaluating a seat belt sign.

Low probability of Significant Intra-Abdominal Injury in Stable Patients with Abdominal ''Seat Belt Sign''

STUDY OBJECTIVE

Our aim was to determine the diagnostic significance of the association between the abdominal skin bruise from a seat belt and the presence of intraabdominal injury.

METHODS

This was an observational analysis of prospectively collected data on 45 patients who presented with an abdominal seat belt sign to a level 1 trauma center following a motor vehicle accident between July 2004 and December 2007. The patients were evaluated by computed tomography (CT) scans or ultrasonography (FAST), depending on their hemodynamic stability. They were then hospitalized for treatment or observation.

RESULTS

Forty-five patients [23 males (51.1%) and 22 females (48.9%)], with a mean age of 32.2 years (range 16-80 years), fulfilled entry criteria and were enrolled. Of these, 44 (97.8%) underwent CT, and one (2.2%) underwent FAST due to hemodynamic instability. two patients (4.4%) had intraabdominal injuries: one required surgery for bowel injury, and the other had a minor liver laceration, which was managed expectantly. Sixteen patients (35.5%) had concomitant injuries. The length of hospital stay ranged from 1-23 days (median 2.2 days).

CONCLUSIONS

Despite the widely accepted view that patients with an abdominal seat belt sign are more likely to have serious intraabdominal injuries, the results of our investigation showed no such association in a group of hemodynamically stable patients.