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 Table of Contents 
CASE REPORT
Year : 2013  |  Volume : 2  |  Issue : 3  |  Page : 288-290  

Seat belt sign and its significance


1 Department of Neurosurgery, Narayana Medical College Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India
2 Department of Forensic Medicine, Hassan Institute of Medical Sciences, Hassan, Karnataka, India
3 Department of Forensic Medicine, Narayana Medical College Hospital, Chinthareddypalem, Nellore, Andhra Pradesh, India

Date of Web Publication29-Oct-2013

Correspondence Address:
Amit Agrawal
Department of Neurosurgery, Narayana Medical College Hospital, Chinthareddypalem, Nellore - 524 003, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2249-4863.120769

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  Abstract 

Safety belts are the most important safety system in motor vehicles and when worn intend to prevent serious injuries. However, in unusual circumstances (high velocity motor vehicle collisions) these safety measures (seat belts) can be the source and cause of serious injuries. The seat belt syndrome was first described as early by Garrett and Braunste in but the term "seat belt sign" was discussed by Doersch and Dozier. Medical personnel's involved in emergency care of trauma patients should be aware of seat belt sign and there should a higher index of suspicion to rule out underlying organ injuries.

Keywords: Seat belt, seat belt injury, seat belt sign


How to cite this article:
Agrawal A, Inamadar PI, Subrahmanyam BV. Seat belt sign and its significance. J Family Med Prim Care 2013;2:288-90

How to cite this URL:
Agrawal A, Inamadar PI, Subrahmanyam BV. Seat belt sign and its significance. J Family Med Prim Care [serial online] 2013 [cited 2019 May 21];2:288-90. Available from: http://www.jfmpc.com/text.asp?2013/2/3/288/120769


  Introduction Top


Safety belts are the most important safety system in motor vehicles and when worn intend to prevent serious injuries. [1],[2],[3] Seat belts reduce the severity of injury caused by restraining vehicle occupants and thus preventing them from hitting objects or being ejected through windows. [4] It has estimated that up to 50-80% of all deaths could have been prevented by properly used a seat belt. [5] However, in unusual circumstances (high velocity motor vehicle collisions) these safety measures (seat belts) can be the source and cause of serious injuries. [6],[7],[8],[9] Kulowski and Rost [10] in 1956 first described seat belt-related injuries. Garrett and Braunstein [8] described the "seat belt syndrome" as early in 1962, but Doersch and Dozier [9] discussed the term "seat belt sign" in 1968. In the present article, we describe an illustrative case of seat belt injuries and review the relevant literature.


  Case Report Top


A 54-year-old gentleman presented with a history of road traffic accident while he was travelling in car got smashed into one pillar. All three fellow passengers were safe. He had history of transient loss of consciousness. There was no history of vomiting, ear, nasal bleed or convulsions. He was complaining of back pain radiating to left lower limb. There was chest pain. There was no pain abdomen. He was a known hypertensive on regular medication. Magnetic resonance imaging lumbosacral spine showed mild L4-5 prolapsed intervertebral disc (PIVD) with left nerve root compression. X-ray chest, abdomen and pelvis were normal. Computed tomography scan chest showed mild pleural effusion on the right side. Ultrasound abdomen was normal. Color Doppler for neck vessels was normal. Local examination revealed an oblique bruise in the neck and another bruise in the right flank (diagonally opposite to the neck bruise) suggestive of seat belt-related injury [Figure 1]. Patient was managed conservatively and did well.
Figure 1: (a) Clinical image showing neck seat belt sign (diagonal abrasions are present along the course of the shoulder strap) and (b) as mall right flank abrasion (abdominal seat belt sign) a in the patient, who was seated on the passenger side of the car

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  Discussion Top


The seat belt sign is characterized by patterned bruising on the chest or abdominal wall corresponding to the position of the diagonal or horizontal strap of the seat belt [11] and can extend to the neck indicating underlying vascular injury. Many studies have demonstrated the association of the seat belt sign and injuries to the neck and chest organs injuries [3] to the lumbar spine, the abdominal organs and its mesentery. [1],[3],[11] It has been concluded that seat belt sign appears to be associated with an increased risk of underlying visceral injuries [12] and front seat passengers presenting with seat belt signs are more than twice as likely to sustain intra-abdominal injury. [1] The presence of these at belt sign should alert the physician to the high likelihood of specific internal injuries. [11] It has been demonstrated that out of 117 injured patients, 12% had a seat belt sign, of which 64% had abdominal injury and in the absence of seat belt sign there were fewer abdominal injuries. [3],[6],[13] Abdominal seat belt sign is not an in controvertible sign of significant internal injuries [3] it has a sensitivity of 25% and specificity of 85%. [6] Patients with a seat belt sign, but without abdominal pain or tenderness appear to be at low risk for intra-abdominal injuries. [14] A high index of suspicion with a low threshold for appropriate diagnostic valuation and/or surgical exploration is recommended for the optimal management of these patients with seat belt sign. [11] Cervical seat belt sign after motor vehicle collision prompt to perform a more thorough examination [15] as it can be an indicator of injury to cervicothoracic vessels. [16],[17] However, mere presence of cervical seat belt sign should not serve as a sole indicator for evaluation of the carotid artery unless there is the presence of other pertinent signs or symptoms. [18]


  Conclusion Top


Seat belt signs remain an important physical finding following motor vehicle crashes. [1] Medical personnel's involved in emergency care of trauma patient should be aware of seat belt sign and there should a higher index of suspicion to rule out underlying organ injuries.

 
  References Top

1.Bansal V, Conroy C, Tominaga GT, Coimbra R. The utility of seat belt signs to predict intra-abdominal injury following motor vehicle crashes. Traffic Inj Prev 2009;10:567-72.  Back to cited text no. 1
    
2.Hodson-Walker NJ. The value of safety belts: A review. Can Med Assoc J 1970;102:391-3.  Back to cited text no. 2
    
3.Hayes CW, Conway WF, Walsh JW, Coppage L, Gervin AS. Seat belt injuries: Radiologic findings and clinical correlation. Radiographics 1991;11:23-36.  Back to cited text no. 3
    
4.Bendak S. Seat belt utilization in Saudi Arabia and its impact on road accident injuries. Accid Anal Prev 2005;37:367-71.  Back to cited text no. 4
    
5.Cummings P. Association of seat belt use with death: A comparison of estimates based on data from police and estimates based on data from trained crash investigators. Inj Prev 2002;8:338-41.  Back to cited text no. 5
    
6.Chidester S, Rana A, Lowell W, Hayes J, Groner J. Is the "seat belt sign" associated with serious abdominal injuries in pediatric trauma? J Trauma 2009;67:S34-6.  Back to cited text no. 6
    
7.Sharma OP, Oswanski MF, Kaminski BP, Issa NM, Duffy B, Stringfellow K, et al. Clinical implications of the seat belt sign in blunt trauma. Am Surg 2009;75:822-7.  Back to cited text no. 7
    
8.Garrett JW, Braunstein PW. The seat belt syndrome. J Trauma 1962;2:220-38.  Back to cited text no. 8
    
9.Doersch KB, Dozier WE. The seat belt syndrome. The seat belt sign, intestinal and mesenteric injuries. Am J Surg 1968;116:831-3.  Back to cited text no. 9
    
10.Kulowski J, Rost WB. Intra-abdominal injury from safety belt in auto accident; report of a case. AMA Arch Surg 1956;73:970-1.  Back to cited text no. 10
    
11.Velmahos GC, Tatevossian R, Demetriades D. The "seat belt mark" sign: A call for increased vigilance among physicians treating victims of motor vehicle accidents. Am Surg 1999;65:181-5.  Back to cited text no. 11
    
12.Rentmeester L. Towards evidence based emergency medicine: Best BETs from the Manchester royal infirmary. BET 1: Does the 'seatbelt sign' predict intra-abdominal injury after motor vehicle trauma in children? Emerg Med J 2012;29:163-4.  Back to cited text no. 12
    
13.Chandler CF, Lane JS, Waxman KS. Seatbelt sign following blunt trauma is associated with increased incidence of abdominal injury. Am Surg 1997;63:885-8.  Back to cited text no. 13
    
14.Sokolove PE, Kuppermann N, Holmes JF. Association between the "seat belt sign" and intra-abdominal injury in children with blunt torso trauma. Acad Emerg Med 2005;12:808-13.  Back to cited text no. 14
    
15.Riviello RJ, Dey CC, Townsend RN, Martin ML. Cervical seat belt sign after motor vehicle collision. Acad Emerg Med 1997;4:335-7.  Back to cited text no. 15
    
16.Rozycki GS, Tremblay L, Feliciano DV, Tchorz K, Hattaway A, Fountain J, et al. A prospective study for the detection of vascular injury in adult and pediatric patients with cervicothoracic seat belt signs. J Trauma 2002;52:618-23.  Back to cited text no. 16
    
17.Ernst A, Robertson HJ, Bercier ML, Kline DG. Occult carotid artery injury related to automobile seat belts. Ann Emerg Med 1988;17:1091-4.  Back to cited text no. 17
    
18.DiPerna CA, Rowe VL, Terramani TT, Salim A, Hood DB, Velmahos GC, et al. Clinical importance of the "seat belt sign" in blunt trauma to the neck. Am Surg 2002;68:441-5.  Back to cited text no. 18
    


    Figures

  [Figure 1]


This article has been cited by
1 Occult Perforation with Circumferential Ischaemic Injury of the Sigmoid Colon following Seat-Belt Trauma: A Case Report
TH Ho,SW Chang,HW Yeh,CB Yeh
Hong Kong Journal of Emergency Medicine. 2017; 24(2): 100
[Pubmed] | [DOI]



 

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