The William Lehman Injury Research Center at the Ryder Trauma Center of the University of Miami/Jackson Memorial Medical Center in Miami Florida conducts interdisciplinary investigations of injured, restrained occupants in frontal automobile collisions. The purpose of this paper is to report on an observed pattern of liver lacerations suffered by drivers wearing shoulder belts, without the lap belt fastened. During the initial 30 months of the study, eight cases of drivers protected by shoulder belts but without the lap belt fastened met the criteria for the study. All eight suffered liver lacerations. In three of the cases, the injuries were not immediately detected.

To place the pattern in context, an analysis of the National Accident Sampling System for the years 1988-1992 shows that liver lacerations occur in less than 0.5% of injured belted drivers who are in tow-away crashes.

Indicators from the crash scene could be helpful to emergency care providers in raising the suspicion of a relatively rare but potentially dangerous liver injury. Based upon multidisciplinary analysis of the eight cases to date, the absence of a lap belt appears to be a strong primary indicator. A crash direction of 1 o'clock and/or damage to the right front of the car are possible secondary indicators.