Published in Acad Emerg Med 2014 Nov 21:1240
Authors: Borgialli DA et al.
Children with a seat belt sign had a tenfold increased risk for undergoing therapeutic laparotomy.
To determine the association between the seat belt sign (a continuous area of erythema, ecchymosis, or abrasion across the abdomen) and intra-abdominal injuries among children in motor vehicle collisions (MVCs), investigators conducted a planned subanalysis of a prospective study of 12,000 children with blunt torso trauma presenting during 3 years to 20 emergency departments in the Pediatric Emergency Care Applied Research Network (PECARN).
Of 3740 children (median age, 12 years) with blunt torso trauma after an MVC, 249 (7%) had intra-abdominal injuries, and 88 (2%) underwent acute intervention (defined as abdominal injury resulting in laparotomy, embolization, blood transfusion, intravenous fluids for ≥2 nights) or died. A total of 585 children (16%) had seat belt signs; of these, 84 (14%) had intra-abdominal injuries, and 40 (7%) underwent acute intervention.
Among 1864 patients who underwent definitive abdominal testing (computed tomography, laparotomy, or autopsy), risk for intra-abdominal injuries was greater in those with a seat belt sign than in those without a seat belt sign (relative risk, 1.6) and was largely attributable to an increased risk for gastrointestinal injuries (RR, 9.4). Children with seat belt signs had an increased risk for undergoing any acute interventions (RR, 4.5), including therapeutic laparotomy (RR, 9.5).
Children with seat belt signs after an MVC require greater scrutiny for intra-abdominal injuries and, at minimum, a prolonged observational stay to assess for gastrointestinal injuries.