Buckle Up! Seat-Belt Related Visceral, Vascular and Vertebral Injuries

Congress:

ECR 2020

Poster Number:

C-10162

Type:

Educational Exhibit

Keywords:

Emergency Imaging, Abdomen, Arteries / Aorta, Musculoskeletal spine, CT, Education, Acute, Not applicable

Authors:

G. Lie , A. Wilson, D. Patel, S. Karamsadkar, S. G. Cross; London/UK

DOI:

10.26044/ecr2020/C-10162

DOI-Link:

https://dx.doi.org/10.26044/ecr2020/C-10162

Fig. 4: A: Drivers-side three-point seatbelt sign, with haematoma at the right...

Fig. 5: CASE 1 1a. 69-year old female front-seat passenger involved in an RTA. Axial...

Fig. 9: CASE 4 4a. 53-year old male driver involved in collision with lamp post. Axial...

Fig. 10: CASE 5 5a. Axial CT of 6-year old backseat passenger involved in an RTA. Fat...

Fig. 11: CASE 5 5c. Coronal CT image demonstrates brachiocephalic traumatic...

$Fig. 14: CASE 7 7a. 27-year old female front-seat passenger involved in collision with tree. Sagittal CT demonstrates a flexion-compression type injury with breach of the anterior and posterior cortex of L4 and loss of vertebral body height 7b. Axial CT demonstrates the fracture has a translational/distraction component which extends into the posterior elements (arrowed). This combined flexion/distraction type injury is termed a “Chance fracture”. 7c. Axial section additionally demonstrates a dissection flap within the left common iliac artery (arrowed)$

Fig. 14: CASE 7 7a. 27-year old female front-seat passenger involved in collision with...

Learning objectives

•To be aware of the constellation of injuries that constitute the seatbelt syndrome •To appreciate the importance ofmaintaining a high index suspicion forthese injuries in the presence of the seatbelt sign

Background

•In the UK, legislation enforcing mandatory seatbelt use for front-seat (1983) and rear-seat passengers (1991) has been responsible for saving over 50 000 lives. It is estimated that lack of seatbelt use has been implicated in a third of fatal road traffic accidents in the UK1,2 •However the restraint offered by the seatbelt can itself be a source of injury, causing sudden deceleration which can result in translational and shearing forces •The seatbelt syndrome describes a specific constellation of injuries associated with the use of...

Findings and procedure details

SEATBELT SYNDROME Visceral/Mesenteric •This is the most common internal injury associated with the seatbelt sign5 •The seatbelt sign is associated with approximately a 10% risk of associated visceral injury6 •Acceleration/deceleration shearing forces particularly affect less mobile regions of bowel such as around the duodenojejunal flexure (Figs. 5 and 8) •Translational forces can cause sudden increases in intraluminal pressure and bowel perforation (Figs. 6 and 7) •Acceleration/deceleration shearing forces can cause mesenteric injury and vascular tears (Fig. 9) •Solid organs such as the pancreas are vulnerable...

Conclusion

•The use of seatbelts has been associated with a large reduction inroad traffic accidentrelated morbidity and mortality •However seatbelt use in the setting of a road traffic accident can also be associated with superficial soft tissue injury- termed the seatbelt sign •When this occurs in the presence of internal injuries- ranging from visceral, vascular, and vertebral injuries- this is termed the seatbelt syndrome •The presence of one injury within the seatbelt syndrome profile should prompt a careful search for other related injuries

Personal information and conflict of interest

G. Lie; London/UK - nothing to disclose A. Wilson; London/UK - nothing to disclose D. Patel; London/UK - nothing to disclose S. Karamsadkar; London/UK - nothing to disclose S. G. Cross; London/UK - nothing to disclose

References

Royal Society for the Prevention of Accidents. Available from: http://www.rospa.com/roadsafety/ National Highway Traffic Safety Administration: Traffic Safety Facts. Research Notes. DOT HS 8111 036; November, 2006. Doersch KB, Dozier WE. The seat belt syndrome: the seat belt sign, intestinal and mesenteric injuries. Am J Surg 1968;116(6):831–833. Hayes CW, Conway WF, Walsh JW, Coppage L, Gervin AS. Seat belt injuries: Radiologic findings and clinical correlation. Radiographics. 1991;11:23–36. Fadl, S. A., & Sandstrom, C. K. Pattern Recognition: A Mechanism-based Approach to Injury Detection after Motor Vehicle Collisions....