title: Is the "seat belt sign" associated with serious abdominal injuries in pediatric trauma?
abstract: BACKGROUND
  The "seat belt sign" (SBS) has been reported to be highly associated with intra-abdominal injury. This study defines its predictive value in identifying injuries in a large pediatric trauma population.
  
  
  METHODS
  At a level I pediatric trauma center, we performed a retrospective review of trauma flow sheets for all motor vehicle crash victims (ages, 0-20) requiring trauma team activation during 2005 and 2006. All patients with an abdominal SBS recorded were included in the analysis.
  
  
  RESULTS
  Of 331 patients (mean age, 9.96 years), an SBS was present in 54 (16%) of these children. Abdominal injury was identified by computed tomography scan or intraoperatively in 12 (22%) of these children. Three (6%) children with SBS required operative intervention. Two had a bowel injuries and one had a negative laparoscopy. SBS and abdominal tenderness were reported in 30 (56%) patients; 8 (15%) of whom sustained abdominal injury. Of the 277 (84%) children without SBS, 36 (13%) had abdominal injuries. Four (11%) of these had a positive laparotomy with three having a bowel injuries. The relative risk of an abdominal injury given an SBS was 1.7 (CI 0.96-2.69; p = 0.078). Four (1.4%) children without SBS died of head injuries compared with zero with SBS. The SBS had a sensitivity of 25% and a specificity of 85%.
  
  
  CONCLUSIONS
  The SBS was not significantly associated with abdominal injury in our population. Patients without SBS had a higher Injury Severity Score and accounted for all of the deaths. SBS may not be as predictive of abdominal injury as previously reported.
authors: Bellevue Hospital, New York, New York, USA.
authors: Sara
authors: S
authors: Chidester
authors: Ankur
authors: A
authors: Rana
authors: Wendi
authors: W
authors: Lowell
authors: John
authors: J
authors: Hayes
authors: Jonathan
authors: J
authors: Groner
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis* / Q000209:etiology*; D000063:Accidents, Traffic; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D012189:Retrospective Studies; D012622:Seat Belts / Q000009:adverse effects*; D012680:Sensitivity and Specificity; D014193:Trauma Centers; D015599:Trauma Severity Indices; D055815:Young Adult