Sokolove Peter E, Kuppermann Nathan, Holmes James F
Department of Emergency Medicine, University of California, Davis, School of Medicine, Sacramento, USA.
Acad Emerg Med. 2005 Sep;12(9):808-13. doi: 10.1197/j.aem.2005.05.004.
To determine the association between an abdominal "seat belt sign" (SBS) and intra-abdominal injury (IAI) in children presenting to the emergency department (ED) after blunt trauma.
The authors performed a prospective, observational study of children at risk for IAI who presented to a Level 1 trauma center following a motor vehicle collision (MVC) during a two-year period. Physical examination findings were recorded prior to abdominal imaging or surgery. The SBS was defined as an area of erythema, ecchymoses, and/or abrasions across the patient's abdominal wall resulting from a seat belt restraint. Patients were divided into two cohorts based on the presence or absence of an SBS, then further subdivided based on abdominal tenderness or pain. The authors compared patients with and without SBS, and those with and without abdominal pain or tenderness for the presence of IAI.
Three hundred ninety children, of whom 46 (12%, 95% CI = 9% to 15%) had an SBS, were enrolled. IAIs were more common in patients with, versus without, an SBS (14/46 vs. 36/344, relative risk 2.9; 95% CI = 1.7 to 5.0; p < 0.001). Patients with an SBS were more likely to have gastrointestinal injuries than those without an SBS (12/46 vs. 7/344, relative risk 12.8; 95% CI = 5.3 to 31; p = 0.001). Pancreatic injuries were also more common among patients with an SBS (3/46 vs. 1/344, relative risk 22; 95% CI = 2.4 to 211; p = 0.006). There was no difference in the prevalence of solid organ injuries between those with and without an SBS (4/46 vs. 34/344, relative risk 0.9, 95% CI = 0.3 to 2.4; p = 1.00). None of the six patients (0%, 95% CI = 0 to 39%) with an SBS, but without abdominal pain or tenderness, had IAIs.
Patients with an SBS after an MVC are more likely to have IAIs than patients without an SBS, predominately due to a higher rate of gastrointestinal injuries. Patients with an SBS but without abdominal pain or tenderness appear to be at low risk for IAI.
确定在钝性创伤后到急诊科就诊的儿童中，腹部“安全带征”（SBS）与腹腔内损伤（IAI）之间的关联。
作者对在两年期间因机动车碰撞（MVC）后到一级创伤中心就诊的有IAI风险的儿童进行了一项前瞻性观察研究。在进行腹部影像学检查或手术前记录体格检查结果。SBS被定义为因安全带约束导致患者腹壁出现红斑、瘀斑和/或擦伤的区域。根据有无SBS将患者分为两个队列，然后根据腹部压痛或疼痛情况进一步细分。作者比较了有和没有SBS的患者，以及有和没有腹痛或压痛的患者中IAI的存在情况。
共纳入390名儿童，其中46名（12%，95%可信区间=9%至15%）有SBS。有SBS的患者比没有SBS的患者更常见IAI（14/46对36/344，相对风险2.9；95%可信区间=1.7至5.0；p<0.001）。有SBS的患者比没有SBS的患者更有可能发生胃肠道损伤（12/46对7/344，相对风险12.8；95%可信区间=5.3至31；p=0.001）。胰腺损伤在有SBS的患者中也更常见（3/46对1/344，相对风险22；95%可信区间=2.4至211；p=0.006）。有和没有SBS的患者中实体器官损伤的患病率没有差异（4/46对34/344，相对风险0.9，95%可信区间=0.3至2.4；p=1.00）。6名有SBS但没有腹痛或压痛的患者中无一例发生IAI（0%，95%可信区间=0至39%）。
MVC后有SBS的患者比没有SBS的患者更有可能发生IAI，主要是由于胃肠道损伤发生率较高。有SBS但没有腹痛或压痛的患者发生IAI的风险似乎较低。
