The spectrum of abdominal injuries associated with the use of seat belts

Rutledge, Robert; Thomason, Michael; Oller, Dale; Meredith, Wayne; Moylan, Joseph; Clancy, Thomas; Cunningham, Paul; Baker, Christopher

Affiliations

¹North Carolina Trauma Registry and Department of Surgery, University of North Carolina School of Medicine

²Department of Surgery, University of North Carolina School of Medicine and Charlotte Memorial Hospital

³Department of Surgery, University of North Carolina School of Medicine and the Wake Medical Center/ Area Health Education Center (AHEC)

⁴Bowman Gray School of Medicine and North Carolina Baptist Hospital

⁵Duke University Medical School and Duke University Medical Center

⁶Department of Surgery, New Hanover Memorial Hospital and Trauma Service, New Hanover Memorial Hospital

⁷Department of Surgery, East Carolina School of Medicine and the Trauma Service, Pitt County Memorial Hospital

⁸Department of Surgery, University of North Carolina School of Medicine and the Trauma Section, North Carolina Memorial Hospital

Abstract

Several recent reports have described abdominal injuries occurring as a result of seat belt use, raising concerns about seat belts as an agent of injury in motor vehicle crashes. The purpose of this study was to characterize the distribution of abdominal injuries after motor vehicle crashes in belted and unbelted patients admitted to trauma centers. The mortality was higher in unbelted than belted patients (7% vs. 3.2%, respectively, p < 0.0001). Unbelted patients also had significantly more frequent and more severe head injuries (50.0% vs. 32.9%, respectively, p < 0.001). The incidence of abdominal injury was equal in both unbelted and belted patients (13.9%), but the spectrum of orgas injuried was different in the two groups. Gastrointestinal tract injuries (stomach, small bowel, colon and rectum) were significantly more freouent in belted vs. unbelted patients (3.4% vs. 1.8%, respectively, p = 0.001). The frequency of liver and spleen injuries was the same in both groups. This study demonstrates that in patients admitted to trauma centers after motor vehicle crashes, belted and unbelted patients have an equal incidence of abdominal injury, but belted and unbelted patients have a different spectrum of injuries. Hollow viscus injuries are more common in belted crash victims. Seat belt use was associated with significantly fewer head injuries and deaths. Physicians evaluating trauma victims after motor vehicle crashes should be aware of the fact that the types of abdominal injuries may vary substantially depending on seat belt use.

Links

DOI: 10.1097/00005373-199106000-00013

PubMed: 2056546

WoS: A1991FT87000013

Ovid: 00005373-199106000-00013

Cited Works (3)

Year	Entry
1986	MacKenzie EJ, Steinwachs DM, Shankar BS, Turney SZ. An ICD-9CM to AIS conversion table: development and application. In: 30th Annual Proceedings, Association for the Advancement of Automotive Medicine (AAAM). October 6, 1986; Montreal, QC.135-151.
1987	Arajärvi E, Santavirta S, Tolonen J. Abdominal injuries sustained in severe traffic accidents by seatbelt wearers. J Trauma. April 1987;27(4):393-397.
1962	Garrett JW, Braunstein PW. The seat belt syndrome. J Trauma. May 1962;2(3):220-238.

Cited By (13)

Year	Entry
2015	Hardy WN, Howes MK, Kemper AR, Rouhana SW. Impact and injury response of the abdomen. In: Yoganandan N, Nahum AM, Melvin JW, eds. Accidental Injury: Biomechanics and Prevention. 3rd ed. New York: Springer; 2015:373-434.
2002	Rouhana SW. Biomechanics of abdominal trauma. In: Nahum AM, Melvin JW, eds. Accidental Injury: Biomechanics and Prevention. 2nd ed. New York, NY: Springer-Verlag; 2002:405-453.
1993	Tso EL, Beaver BL, Haller JA Jr. Abdominal injuries in restrained pediatric passengers. J Pediatr Surg. 1993;28(7):915-919.
2000	Weber K. Crash protection for child passengers: a review of best practice. UMTRI Res Rev. July–September 2000;31(3):1-27.
2002	Weber K. Child passenger protection. In: Nahum AM, Melvin JW, eds. Accidental Injury: Biomechanics and Prevention. 2nd ed. New York, NY: Springer-Verlag; 2002:523-549.
1994	Cooper KD, Proctor SM, Ragland DR, Barkan H. Seat belt syndrome: an examination of patterns of injury associated with seat belt use. In: 38th Annual Proceedings, Association for the Advancement of Automotive Medicine (AAAM). September 21-23, 1994; Lyon, France.11-23.
1998	Bandstra R, Meissner U, Warner CY, Monoghan S, Mendelsohn R, MacPherson D. Seat-belt injuries in medical and statistical perspectives. In: Proceedings of the 16th International Technical Conference on the Enhanced Safety of Vehicles (ESV). May 31–June 4, 1998; Windsor, Ontario, Canada.1347-1359.
2013	Howes MK, Hardy WN. Dynamic material properties of the post‐mortem human colon. In: Proceedings of the 2013 International IRCOBI Conference on the Biomechanics of Injury. September 11-13, 2013; Gothenburg, Sweden.124-132.
2012	Howes MK, Hardy WN. Material properties of the post-mortem small intestine in high-rate equibiaxial elongation. In: Proceedings of the 8th Ohio State University Injury Biomechanics Symposium. May 13-15, 2012; Columbus, OH.
1994	Lane JC. The seat belt syndrome in children. Accid Anal Prev. 1994;26(6):813-820.
2001	Yoganandan N, Pintar FA, Maltese MR. Biomechanics of abdominal injuries. Crit Rev Biomed Eng. 2001;29(2):173-246.
1999	Klena JW, Kihara T, Graves C. Case study: correlation between the seat belt sign and positive abdominal computed tomography findings in pediatric trauma patients. J Crash Prev Injury Control. 1999;1(1):63-66.
2013	Howes MK. Injury Mechanisms, Tissue Properties, and Response of the Post-Mortem Human Abdomen in Frontal Impact [PhD thesis]. Virginia Polytechnic Institute and State University; 2013.