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Excluding Hollow Viscus Injury for Abdominal Seat Belt Sign Using Computed Tomography
Patrick T Delaplain1, Erika Tay-Lasso1, Walter L Biffl2
1Division of Trauma, Burns, & Surgical Critical Care, University of California, Irvine.
JAMA Surgery
|July 13, 2022
Summary
A negative CT scan effectively rules out hollow viscus injury (HVI) in patients with abdominal seat belt sign (SBS). This finding suggests that routine admission and observation for abdominal SBS may be unnecessary, potentially saving resources.
Area of Science:
- Trauma Surgery
- Diagnostic Imaging
- Abdominal Trauma
Background:
- Abdominal seat belt sign (SBS) historically necessitates admission due to CT limitations and high hollow viscus injury (HVI) rates.
- Recent studies challenge the routine admission and observation practice for abdominal SBS.
Purpose of the Study:
- To determine if a negative computed tomography (CT) scan can reliably exclude HVI in patients presenting with an abdominal SBS.
Main Methods:
- Prospective observational cohort study across 9 Level I trauma centers.
- Included adult trauma patients with abdominal SBS undergoing CT as part of initial evaluation.
- CT findings indicative of injury were predefined; HVI diagnosis was confirmed intraoperatively.
Main Results:
- Out of 754 patients, HVI prevalence was 9.2% (69 patients).
- Only 1 patient (0.1%) with HVI had a negative CT scan.
- Free fluid on CT showed the strongest association with HVI (OR, 42.68) and was the best predictor (AUC, 0.87).
Conclusions:
- The incidence of HVI in patients with abdominal SBS and a negative CT scan is extremely low.
- Reconsidering routine admission for abdominal SBS with negative CT findings can lead to significant resource and cost savings.
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