"Seat Belt Sign" in Children Is Associated with Intraabdominal Injuries

Use of seat belts has dramatically decreased motor vehicle collision (MVC) fatality rates, but their use by children is associated with particular injuries, often due to incorrect positioning of the restraint or use of a seat belt by children whose size would mandate a booster seat or car seat. These authors assessed the association between "seat belt sign" and risk for intraabdominal injury in children. The authors defined seat belt sign as "an area of erythema, ecchymoses, and/or abrasions extending across the patient’s abdomen resulting from a seat belt restraint."
In a prospective observational study, 390 children who presented to a single emergency department with blunt trauma after a MVC were evaluated for presence of seat belt sign and either abdominal pain or tenderness. All testing and interventions were done at the discretion of the treating medical team. Seat belt sign was identified in 46 patients (12%). Presence of seat belt sign was associated with a significantly increased risk for intraabdominal injury (30% vs. 10%; relative risk, 2.9). Most of the increase in risk was attributed to injuries to the gastrointestinal tract (26% vs. 2%; RR, 12.8) and pancreas (7.0% vs. 0.3%; RR, 22.4). Comment Abdominal imaging is commonly ordered for adults who have abdominal pain or tenderness or altered mental status or intoxication after MVCs to rule out intraabdominal injury. This study shows that the practice is also valuable for children who present with seat belt sign. Of note, FAST ultrasound scanning is not adequate, as it might not identify gastrointestinal and pancreatic injuries. Newer helical computed tomography scanners pick up more than 90% of such injuries.
— Diane M. Birnbaumer, MD, FACEP Published in Journal Watch Emergency Medicine November 29, 2005