A prospective study for the detection of vascular injury in adult and pediatric patients with cervicothoracic seat belt signs.
BACKGROUND
A delayed diagnosis of injury to cervicothoracic vessels from blunt trauma may cause significant adverse sequelae. The association of a cervicothoracic seat belt sign with such an injury is unknown.


METHODS
Algorithms were prospectively studied for the detection of occult vascular injury in patients with cervicothoracic seat belt signs. Patients with neck seat belt signs underwent arteriography or computed tomographic angiography (CTA). Those with thoracic seat belt signs underwent aortography/arteriography if a ruptured thoracic aorta or injury to a great vessel was suspected or a neurovascular abnormality was present.


RESULTS
During a 17-month period, 797 patients were admitted to the trauma service secondary to motor vehicle crashes. One hundred thirty-one (16.4%) had cervical or thoracic seat belt signs. Four (3%) of the patients had carotid artery injuries, the presence of which was strongly associated with a Glasgow Coma Scale score < 14, an Injury Severity Score > 16 (p < 0.0001), and the presence of a clavicle and/or first rib fracture (p < 0.0037). Of the remaining patients, 17 had thoracic trauma. There were no vascular injuries in the children and only one had thoracic trauma.


CONCLUSIONS
The algorithms are safe and accurate for the detection of cervicothoracic vascular injury in adult and pediatric patients with seat belt signs. The cervicothoracic seat belt mark and an abnormal physical examination are an effective combination in screening for cervicothoracic vascular injury.
Rozycki
Grace S
GS
Department of Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, Georgia 30303, USA.
Tremblay
Lorraine
L
Feliciano
David V
DV
Tchorz
Kathryn
K
Hattaway
Aaron
A
Fountain
Jack
J
Pettitt
Barbara J
BJ
D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D000792:Angiography; D020212:Carotid Artery Injuries / Q000000981:diagnostic imaging / Q000209:etiology*; D002648:Child; D002675:Child, Preschool; D015600:Glasgow Coma Scale; D006801:Humans; D007223:Infant; D008875:Middle Aged; D009333:Neck / Q000098:blood supply*; D011446:Prospective Studies; D012622:Seat Belts / Q000009:adverse effects*; D013909:Thorax / Q000098:blood supply*; D014949:Wounds, Nonpenetrating / Q000150:complications*