The use of computed tomography imaging for abdominal seatbelt sign: A single-center, prospective evaluation. Issue 1 (January 2020)

• Record Type: Journal Article
• Authors: Delaplain, Patrick T.; Barrios, Cristobal; Spencer, Dean; Lekawa, Michael; Schubl, Sebastian; Dosch, Austin; Grigorian, Areg; Smith, Megan; Pejcinovska, Marija; Nahmias, Jeffry
• Is Part Of: Injury. Volume 51:Issue 1(2020)
• Page Start: 26
• Page End: 31
• Publication Date: 2020-01
• Subjects: Seatbelt -- Seatbelt sign -- Hollow viscous injury -- Bowel injury -- Blunt abdominal injury -- Motor vehicle crash; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2019.10.089
• Languages: English
• ISSNs: 0020-1383

Abstract

Highlights: This study represents a large, prospective collection of patients with abdominal seatbelt sign (SBS) in the modern era of computed tomography (CT) imaging. There were no patients in this study with a negative CT scan who required operation for hollow viscus injury. There is likely a subset of patients with abdominal SBS who could be safely discharged home from the emergency department. 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.