title: Predictive indicators for bowel injury in pediatric patients who present with a positive seat belt sign after motor vehicle collision.
abstract: OBJECTIVE
  Abdominal wall bruising (AWB) is a frequent finding in children wearing seat belts involved in motor vehicle collision (MVC) and is highly suspicious but not indicative of intestinal injury. The aim of this study was to find objective clinical and radiologic predictors for the need of an abdominal exploration in these children.
  
  
  METHODS
  A retrospective chart review of children admitted from 1998 and 2008 with AWB after MVC was conducted. Demographics, vital signs, physical examinations, radiologic investigations, associated injuries, management, and outcome were extracted. Univariate and multivariate statistical analyses were done.
  
  
  RESULTS
  Fifty-three children with a median age of 9 years (range, 3-16 years) were included. Forty-four patients (83%) had abdominal pain on arrival, and 25 (47%) had free intraabdominal fluid on ultrasound/scan. Intraabdominal injuries were noted in 29 patients (55%), and the most common were mesenteric or bowel injuries (25%), splenic injuries (13%), and hepatic injuries (8%). Ten patients (19%) needed therapeutic laparotomy, and all were victims from collision involving 2 moving vehicles, had abdominal pain, free intraabdominal fluid, and tachycardia. Five patients (50%) operated on had lumbar fracture compared to only 4 patients (9%) in the nonoperative group. Pulse rate higher than 120 (P = .048), lumbar fracture (P = .008), and free intraabdominal fluid (P <or= .001) were significant predictors for intestinal perforation. Overall survival was 98% with 1 death because of head trauma.
  
  
  CONCLUSIONS
  Intraabdominal injuries in children with AWB after MVC are frequent. Associated lumbar fracture, the presence of free intraabdominal fluid, and pulse rate higher than 120 are significant predictors of intestinal injuries. An abdominal exploration should be considered in these patients.
authors.affiliation: Division of Pediatric Surgery, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Québec, Canada, H3T 1C5.
authors.forename: Catherine
authors.initials: C
authors.lastname: Paris
authors.forename: Mahli
authors.initials: M
authors.lastname: Brindamour
authors.forename: Alain
authors.initials: A
authors.lastname: Ouimet
authors.forename: Dickens
authors.initials: D
authors.lastname: St-Vil
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D015746:Abdominal Pain / Q000453:epidemiology / Q000209:etiology; D000063:Accidents, Traffic; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003288:Contusions / Q000453:epidemiology / Q000209:etiology; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D007422:Intestines / Q000293:injuries*; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011792:Quebec / Q000453:epidemiology; D012189:Retrospective Studies; D012622:Seat Belts / Q000009:adverse effects*; D016103:Spinal Fractures / Q000453:epidemiology / Q000209:etiology