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Seat Belt Sign
Aka: Seat Belt Sign, Seat Belt Syndrome, Seatbelt Sign
- See Also
- Adult Safety Belt
- Child Safety Seat
- Signs
- Abdominal abrasions and Contusions associated with Seat Belt restraint
- Precautions
- Seat Belts restraints are critical protection against ejection and serious Head Injury
- Benefits of Seat Belts 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 Signs
- 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 Bruises
- 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 Restraints significantly reduce the risk of injury and death, but must be used properly
- Car Seats should be used up to age 4 years old (rear facing until age 2 years)
- Booster Seats 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]