Association Between the Seat Belt Sign and Intra-abdominal Injuries in Children With Blunt Torso Trauma in Motor Vehicle Collisions

作者：Borgialli Dominic A^*; Ellison Angela M; Ehrlich Peter; Bonsu Bema; Menaker Jay; Wisner David H; Atabaki Shireen; Olsen Cody S; Sokolove Peter E; Lillis Kathy; Kuppermann Nathan; Holmes James F

来源：ACADEMIC EMERGENCY MEDICINE, 2014, 21(11): 1240-1248.

DOI：10.1111/acem.12506

ObjectivesThe 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). %26lt;br%26gt;MethodsThis 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. %26lt;br%26gt;ResultsA 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. %26lt;br%26gt;ConclusionsPatients 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. %26lt;br%26gt;Resumen %26lt;br%26gt;ObjetivosDeterminar la asociacion entre el signo del cinturon de seguridad (SCS) y las lesiones intra-abdominales (LIA) en los ninos atendidos en los servicios de urgencias por traumatismo toracico cerrado tras colisiones de vehiculo de motor (CVM). %26lt;br%26gt;MetodologiaEste fue un analisis de subgrupo planificado de los datos prospectivos de un estudio de cohorte multicentrico de ninos con traumatismo toracico cerrado tras CVM. Se documento la historia clinica y la exploracion fisica del paciente antes de la tomografia computarizada (TC) abdominal o la laparotomia. El SCS se definio como un area continua de eritema, equimosis o abrasion a traves del abdomen secundaria a la contencion del cinturon de seguridad. Se calculo el riesgo relativo (RR) de LIA con los intervalos de confianza (IC) al 95% para los ninos con SCS en comparacion con aquellos que no lo tenian. Tambien se calculo 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). %26lt;br%26gt;ResultadosSe incluyeron 3.740 ninos tras un traumatismo toracico cerrado en CVM; 585 (16%) tuvieron SCS. Entre los 1.864 ninos en los que se llevo a cabo un test diagnostico abdominal definitivo (TC, laparotomia/ laparoscopia, o autopsia), las LIA fueron mas frecuentes en los pacientes con SCS que en aquellos 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 (viscera hueca o asociadas al mesenterio) en aquellos con SCS (11% vs. 1%, RR=9,4; IC 95%=5,4 a 16,4). La LIA se diagnostico 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. %26lt;br%26gt;ConclusionesLos pacientes con SCS tras una CVM tienen mayor riesgo de LIA que aquellos sin SCS, debido fundamentalmente a lesiones gastrointestinales. Aunque las LIA son menos comunes en los pacientes con SCS que estan alerta y que no tienen quejas iniciales de molestia o dolor abdominal, el riesgo de LIA es suficiente para que evaluaciones como la observacion, las pruebas de laboratorio y potencialmente la TC abdominal sean generalmente necesarios.

• 出版日期2014-11