Beware the Seatbelt Sign in Children

Short Attention Span Summary

Beware the seatbelt sign
This is an FYI article.  If you're not aware, the seatbelt sign, or big bruise on the low abdomen from being thrown forward and caught by the belt, is a marker of significant intraabdominal injury in children.  They describe a case of delayed intestinal obstruction in a child with a seatbelt sign and discuss this injury pattern.  The pearls are that it is often associated with improper use of the car restraint system.  Seatbelt sign is associated with, "9% to 21% risk of solid organ injury and 11% to 25% risk of GI injury."  Authors state the NNT is 9, meaning that for every 9 kids with seatbelt sign, 1 will have something bad.  It can also produce spine fractures from the deceleration about the fixed fulcrum of the lap belt, most commonly the Chance fracture.  Seatbelt sign doesn't always mean badness, but take it seriously.  Watch these patients for an extended period of time.  If they have a tender abdomen, even in the setting of negative CT, admit for observation and serial exams.  Even those with a seatbelt sign but no pain or tenderness will need surgery 2% of the time, so one could argue that all these kids need admission and serial exams.

Spoon Feed
A seatbelt contusion on a child's abdomen is a marker of significant and potentially subtle abdominal or spine injury.


Abstract

Pediatr Emerg Care. 2017 Feb;33(2):120-125. doi: 10.1097/PEC.0000000000001027.

Seatbelt Syndrome in Children.

Szadkowski MA1, Bolte RG.

Author information:

1Clinical Professor (Bolte) and Clinical Assistant Professor (Szadkowski), Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT.

Abstract

The seatbelt syndrome describes an injury pattern infrequently seen in restrained passengers in motor vehicle collisions. It occurs when sudden deceleration forces coupled with compression of the lap belt around the abdomen causes abdominal wall bruising, intra-abdominal injuries, and spinal fractures. Infrequent and improper use of appropriate belt restraints in children has led to high risks for injury in this population.We describe a case of the seatbelt syndrome with the uncommon finding of an associated posttraumatic intestinal obstruction. We also review the literature on the prevalence, risk factors, and types of injuries sustained by children with the seatbelt syndrome as well as discuss the indications for laboratory studies, abdominal imaging, surgical intervention, and further observation. Current recommendations for child seatbelt use and its effectiveness in preventing injury are also reviewed.

PMID: 28141769 [PubMed - in process]

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