Association between the seat belt sign and intra-abdominal injuries in children with blunt torso trauma in motor vehicle collisions

Abstract

Objectives The objective was to determine the association between the abdominal seat belt sign and intra-abdominal injuries (IAIs) in children presenting to emergency departments with blunt torso trauma after motor vehicle collisions (MVCs). Methods This was a planned subgroup analysis of prospective data from a multicenter cohort study of children with blunt torso trauma after MVCs. Patient history and physical examination findings were documented before abdominal computed tomography (CT) or laparotomy. Seat belt sign was defined as a continuous area of erythema, ecchymosis, or abrasion across the abdomen secondary to a seat belt restraint. The relative risk (RR) of IAI with 95% confidence intervals (CIs) was calculated for children with seat belt signs compared to those without. The risk of IAI in those patients with seat belt sign who were without abdominal pain or tenderness, and with Glasgow Coma Scale (GCS) scores of 14 or 15, was also calculated. Results A total of 3,740 children with seat belt sign documentation after blunt torso trauma in MVCs were enrolled; 585 (16%) had seat belt signs. Among the 1,864 children undergoing definitive abdominal testing (CT, laparotomy/laparoscopy, or autopsy), IAIs were more common in patients with seat belt signs than those without (19% vs. 12%; RR = 1.6, 95% CI = 1.3 to 2.1). This difference was primarily due to a greater risk of gastrointestinal injuries (hollow viscous or associated mesentery) in those with seat belt signs (11% vs. 1%; RR = 9.4, 95% CI = 5.4 to 16.4). IAI was diagnosed in 11 of 194 patients (5.7%; 95% CI = 2.9% to 9.9%) with seat belt signs who did not have initial complaints of abdominal pain or tenderness and had GCS scores of 14 or 15. Conclusions Patients with seat belt signs after MVCs are at greater risk of IAI than those without seat belt signs, predominately due to gastrointestinal injuries. Although IAIs are less common in alert patients with seat belt signs who do not have initial complaints of abdominal pain or tenderness, the risk of IAI is sufficient that additional evaluation such as observation, laboratory studies, and potentially abdominal CT scanning is generally necessary. Resumen Objetivos Determinar la asociaciõn entre el signo del cinturõn de seguridad (SCS) y las lesiones intra-abdominales (LIA) en los niños atendidos en los servicios de urgencias por traumatismo torácico cerrado tras colisiones de vehículo de motor (CVM). Metodología Éste fue un análisis de subgrupo planificado de los datos prospectivos de un estudio de cohorte multicéntrico de niños con traumatismo torácico cerrado tras CVM. Se documentõ la historia clínica y la exploraciõn física del paciente antes de la tomografía computarizada (TC) abdominal o la laparotomía. El SCS se definiõ como un área continua de eritema, equimosis o abrasiõn a través del abdomen secundaria a la contenciõn del cinturõn de seguridad. Se calculõ el riesgo relativo (RR) de LIA con los intervalos de confianza (IC) al 95% para los niños con SCS en comparaciõn con aquéllos que no lo tenían. También se calculõ el riesgo de LIA en aquellos pacientes con SCS que no tuvieron molestia o dolor abdominal con puntuaciones de 14 o 15 de la Escala de Coma de Glasgow (ECG). Resultados Se incluyeron 3.740 niños tras un traumatismo torácico cerrado en CVM; 585 (16%) tuvieron SCS. Entre los 1.864 niños en los que se llevõ a cabo un test diagnõstico abdominal definitivo (TC, laparotomía/ laparoscopia, o autopsia), las LIA fueron más frecuentes en los pacientes con SCS que en aquéllos sin SCS (19% vs. 12%, RR = 1,6; IC 95% = 1,3 a 2,1). Esta diferencia fue principalmente debida a un mayor riesgo de lesiones gastrointestinales (víscera hueca o asociadas al mesenterio) en aquéllos con SCS (11% vs. 1%, RR = 9,4; IC 95% = 5,4 a 16,4). La LIA se diagnosticõ en 11 de 194 pacientes (5,7%, IC 95% = 2,9% a 9,9%) con SCS que no tuvieron quejas iniciales de molestia o dolor abdominal y tuvieron puntuaciones de 14 o 15 en la ECG. Conclusiones Los pacientes con SCS tras una CVM tienen mayor riesgo de LIA que aquéllos sin SCS, debido fundamentalmente a lesiones gastrointestinales. Aunque las LIA son menos comunes en los pacientes con SCS que están alerta y que no tienen quejas iniciales de molestia o dolor abdominal, el riesgo de LIA es suficiente para que evaluaciones como la observaciõn, las pruebas de laboratorio y potencialmente la TC abdominal sean generalmente necesarios.