Seat Belt Sign

1. Signs
   1. Abdominal abrasions and Contusions associated with Seat Belt restraint
2. Precautions
   1. Seat Belts restraints are critical protection against ejection and serious Head Injury
   2. Benefits of Seat Belts far outweigh the risks of Seat Belt Syndrome
3. Complications: Seat Belt Sign
   1. Aortic Injury
   2. Abdominal organ injury (lap belt injury)
      1. Seat Belt Sign is associated with abdominal organ injury in 65% of cases
      2. Associated with mesentary bucket handle injury and Small Bowel injury
         1. Risk of bowel ischemia and delayed peritonitis
      3. Relative Risk of significant intra-Abdominal Injury: 8
      4. Obtain CT Abdomen in nearly all cases
         1. Negative CT Abdomen
            1. Consider observation for 12-24 hours (East U.S. Trauma Surgery Guidelines)
            2. Close interval follow-up may be acceptable (discuss with local Trauma surgery)
         2. Equivocal CT Abdomen (trace free fluid, bowel wall thickening or stranding)
            1. Observe for 12-24 hours with serial examinations
            2. Surgery for fever, peritoneal signs, clinically worsening
            3. May disposition home if pain resolved, tolerating fluids, stable Vital Signs
         3. Positive CT Abdomen
            1. Surgery (Laparotomy)
   3. Lumbar Fracture at L1 (Chance Fracture)
      1. Uncommon, but high risk, unstable Fracture associated with Seat Belt use without Shoulder restraint
      2. Surgery evaluation required to determine Fracture stability
   4. Blunt Neck Trauma
      1. Associated with Shoulder belt
      2. Presents with anterior neck Bruises
      3. May be associated with Laryngeal Fracture, tracheal Fracture, carotid injury
4. References
   1. Spangler and Inaba in Herbert (2016) EM:Rap 16(5): 6-7
   2. Trauma Professional's Blog
      1. http://regionstraumapro.com/post/663723636