Recognizing which children involved in an automobile accident have serious internal injuries can be a very difficult task for both physicians and parents. Some recent information, gathered by the Pediatric Academic Societies, seems to have made that recognition a little easier, however. These investigators have found that children with external marks from seatbelt injuries, also called the “seatbelt sign,” had a much higher probability of internal injures after a car accident. When young auto accident patients enter Emergency Departments (EDs), doctors are increasingly recognizing that bruising on the chest or abdomen from seatbelt trauma often means trouble, even if the child has little or no pain.
What is this “seatbelt sign?” Well, this physical sign is an elongated area of redness with possible bruising and tenderness on the skin caused by pressure from the seat belt during a collision. Although seen in adult accident patients as well, this bruising can be far more painful for small children and adolescents. Investigators surveyed 3,740 pediatric patients from multiple EDs after auto accidents. 16% had the seat-belt sign present while 84% did not. One in ten of the children with external seatbelt marks had serious internal injuries, especially intra-abdominal, regardless of whether they had pain. Researchers concluded that external marks from a seat-belt are an important sign for parents and doctors to recognize after an auto accident.
This new data indicates that it is important for both physicians and parents to pay close attention to any bruises or areas of swelling on children involved in an auto accident, since these marks may indicate underlying serious injuries. This study also indicated that the seatbelt sign is not the only indication of abdominal injury; changes in a child’s breathing, low blood pressure, and abdominal tenderness were some of the other significant associated factors for detecting intra-abdominal injury. Dr. Angela Ellison, an emergency physician with the Children’s Hospital of Philadelphia, reported that children with this seatbelt sign remain at high risk of injury, most notably gastrointestinal injury. Parents and doctors alike need to recognize and act on this important physical sign.
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Written collaboratively by norman Spencer and Paul Smolen M.D.