Citation

Delaplain PT, Barrios C, Spencer D, Lekawa M, Schubl S, Dosch A, Grigorian A, Smith M, Pejcinovska M, Nahmias J. Injury 2019; ePub(ePub): ePub.

Affiliation

Division of Trauma, Burns and Critical Care, University of California, Irvine Medical Center, United States.

Copyright

(Copyright © 2019, Elsevier Publishing)

DOI

10.1016/j.injury.2019.10.089

PMID

31706587

Abstract

INTRODUCTION: Guidelines surrounding abdominal seat belt sign (SBS) were made prior to the use of modern computed tomography (CT) imaging. We sought to prospectively determine whether a negative CT scan is associated with the absence of hollow viscus injury (HVI), and we hypothesized that trauma patients with an abdominal SBS without CT imaging findings would not have a hollow viscus injury (HVI).

METHODS: A prospective cohort of patients with SBS was compiled over one year. Subjects were divided into those with and without HVI. Covariate distributions were summarized by group. Bivariate tests and logistic regression were used to investigate associations between covariates and HVI.

RESULTS: Of 220 patients with SBS, the incidence of HVI was 7% (n = 15). Radiographic findings were strongly associated with HVI and no patients with a negative CT scan had HVI. Free fluid was seen in 80% (12) of patients with HVI, whereas it was found in only 11% (23) without injury. A composite variable for negative CT scan was found to be associated with the absence of HVI: (Fisher's exact 1-tailed p, doubled = 0.014).

CONCLUSION: In this study, the incidence of HVI with SBS is lower than previously reported, and no patients with negative CT imaging required an operation for HVI-suggesting there is a population of patients with SBS who could be discharged from the emergency room. A prospective multicenter study is needed to confirm these findings.

Copyright © 2019 Elsevier Ltd. All rights reserved.

Language: en

Keywords

Blunt abdominal injury; Bowel injury; Hollow viscous injury; Motor vehicle crash; Seatbelt; Seatbelt sign