III. Precautions
- Seat Belts restraints are critical protection against ejection and serious Head Injury
- Benefits of Seat Belts far outweigh the risks of Seat Belt Syndrome
IV. Pathophysiology
- Seat Belt Syndrome
- Lap belt acts as a fulcrum with flexion and other injuries (spine, viscus, vasculature) in this plane
V. Complications: Seat Belt Syndrome in Adults
- Aortic Injury
- Abdominal organ injury (Lap belt injury)
- Seat Belt Sign is associated with abdominal organ injury in 65% of cases
- Associated with mesentary bucket handle injury and Small Bowel injury
- Risk of bowel ischemia and delayed peritonitis
- Relative Risk of significant intra-Abdominal Injury: 8
- Obtain CT Abdomen in nearly all cases
- Negative CT Abdomen
- Equivocal CT Abdomen (trace free fluid, bowel wall thickening or stranding)
- Observe for 12-24 hours with serial examinations
- Surgery for fever, peritoneal signs, clinically worsening
- May disposition home if pain resolved, tolerating fluids, stable Vital Signs
- Positive CT Abdomen
- Surgery (Laparotomy)
- Lumbar Fracture at L1 (Chance Fracture)
-
Blunt Neck Trauma
- Associated with Shoulder belt
- Presents with anterior neck Bruises
- May be associated with Laryngeal Fracture, tracheal Fracture, carotid injury
VI. Complications: Seat Belt Syndrome in Children
- See Pediatric Blunt Abdominal Trauma
- See Pediatric Blunt Abdominal Trauma Decision Rule
- Seat Belt Sign had intraabdominal injuries in 5.7% of children without Abdominal Pain, tenderness (2% required surgery)
-
Car Restraints significantly reduce the risk of injury and death, but must be used properly
- Car Seats should be used up to age 4 years old (rear facing until age 2 years)
- Booster Seats should be used from age 4-8 years old (until height >=57 inches)
- Lap belt is intended to rest over the pelvic brim (anterior superior iliac spine)
- Seat Belt Syndrome associated injuries in children
- Lumbar Fracture or Chance Fracture (esp. L2-3)
- Associated with Abdominal Injury concurrently in 15% of cases
- Gastrointestinal Trauma (present in 11% of cases with Seat Belt Sign)
- Lumbar Fracture or Chance Fracture (esp. L2-3)
-
Blunt Neck Trauma related to Shoulder belt
- See Blunt Neck Trauma
- Higher risk of neck injury if premature transition from Booster Seat to lap-Shoulder belt
VII. References
- McClung and Ruttan (2019) Crit Dec Emerg Med 33(3): 3-11
- Spangler and Inaba in Herbert (2016) EM:Rap 16(5): 6-7
- Trauma Professional's Blog
- Lutz (2004) J Pediatr Surg 39(6): 972-5 [PubMed]
- Borgialli (2014) Acad Emerg Med 21(11): 1240-8 [PubMed]