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Seat Belt Sign
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Seat Belt Sign
, Seat Belt Syndrome, Seatbelt Sign
See Also
Adult Safety Belt
Child Safety Seat
Signs
Abdominal abrasions and
Contusion
s associated with
Seat Belt
restraint
Precautions
Seat Belt
s restraints are critical protection against ejection and serious
Head Injury
Benefits of
Seat Belt
s far outweigh the risks of Seat Belt Syndrome
Pathophysiology
Seat Belt Syndrome
Lap belt
acts as a fulcrum with flexion and other injuries (spine, viscus, vasculature) in this plane
Complications
Seat Belt Syndrome in Adults
Aortic Injury
Abdominal organ injury (
Lap belt
injury)
Seat Belt Sign is associated with abdominal organ injury in 65% of cases
Associated with mesentary bucket handle injury and
Small Bowel
injury
Risk of bowel ischemia and delayed peritonitis
Relative Risk
of significant intra-
Abdominal Injury
: 8
Obtain
CT Abdomen
in nearly all cases
Negative
CT Abdomen
Consider observation for 12-24 hours (East U.S.
Trauma
Surgery Guidelines)
Close interval follow-up may be acceptable (discuss with local
Trauma
surgery)
Equivocal
CT Abdomen
(trace free fluid, bowel wall thickening or stranding)
Observe for 12-24 hours with serial examinations
Surgery for fever, peritoneal signs, clinically worsening
May disposition home if pain resolved, tolerating fluids, stable
Vital Sign
s
Positive
CT Abdomen
Surgery (Laparotomy)
Lumbar
Fracture
at L1 (
Chance Fracture
)
Uncommon, but high risk, unstable
Fracture
associated with
Seat Belt
use without
Shoulder
restraint
Surgery evaluation required to determine
Fracture
stability
Blunt Neck Trauma
Associated with
Shoulder
belt
Presents with anterior neck
Bruise
s
May be associated with
Laryngeal Fracture
, tracheal
Fracture
, carotid injury
Complications
Seat Belt Syndrome in Children
See
Pediatric Blunt Abdominal Trauma
See
Pediatric Blunt Abdominal Trauma Decision Rule
Seat Belt Sign had intraabdominal injuries in 5.7% of children without
Abdominal Pain
, tenderness (2% required surgery)
Mahajan (2015) Acad Emerg Med 22(9): 1034-41 [PubMed]
Car Restraint
s significantly reduce the risk of injury and death, but must be used properly
Car Seat
s should be used up to age 4 years old (rear facing until age 2 years)
Booster Seat
s should be used from age 4-8 years old (until height >=57 inches)
Premature use of the adult
Shoulder
-
Lap belt
risks neck extension and flexion injuries
Lap belt
is intended to rest over the pelvic brim (anterior superior iliac spine)
Younger child
Pelvis
can not support the
Lap belt
restraint
Restraint may ride high over the soft tissues of the
Abdomen
in children
Results in greater transmission of MVA forces to the spine, vessels and organs
Seat Belt Syndrome associated injuries in children
Lumbar
Fracture
or
Chance Fracture
(esp. L2-3)
Associated with
Abdominal Injury
concurrently in 15% of cases
Gastrointestinal
Trauma
(present in 11% of cases with Seat Belt Sign)
Bowel
perforation
Bowel
wall
Hematoma
Mesenteric tear
Mesenteric vessel devascularization
Solid organ injury is less well correlated but may affect
Spleen
, liver,
Kidney
or
Pancreas
Blunt Neck Trauma
related to
Shoulder
belt
See
Blunt Neck Trauma
Higher risk of neck injury if premature transition from
Booster Seat
to lap-
Shoulder
belt
References
McClung and Ruttan (2019) Crit Dec Emerg Med 33(3): 3-11
Spangler and Inaba in Herbert (2016) EM:Rap 16(5): 6-7
Trauma
Professional's Blog
http://regionstraumapro.com/post/663723636
Lutz (2004) J Pediatr Surg 39(6): 972-5 [PubMed]
Borgialli (2014) Acad Emerg Med 21(11): 1240-8 [PubMed]
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