Johnson Michael C, Eastridge Brian J
University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
Am J Surg. 2017 Dec;214(6):1175-1179. doi: 10.1016/j.amjsurg.2017.08.041. Epub 2017 Sep 18.
The abdominal seatbelt sign (ASBS) has an established association with abdominal injury, yet its definition remains ill-defined. We hypothesize specific imaging characteristics associated with the ASBS such as location above the pelvic brim and depth of abdominal wall contusion would better predict underlying injury and need for operative intervention.
We performed a retrospective chart review of subjects suffering from restrained motor vehicle collisions (MVC) evaluated at a level one trauma facility from 2010 to 2015. CT imaging was reviewed for the presence of a transverse abdominal wall contusion consistent with lap belt use. Contusion location was determined in relation to the anterior superior iliac spine (ASIS). Abdominal wall thickness as well as contusion depth were measured at the contusion level and an abdominal seatbelt sign depth index (ASBSI) was calculated.
Sample size for the cohort was 551 subjects. Operative need was 19.73% in those with ASBS on CT (CT ASBS) above the ASIS and 4.05% (p-value < 0.01) in those with only clinical evidence of ASBS (CL ASBS). CT ASBS above the ASIS was associated with higher incidence of intra-abdominal injuries (31.97% vs 16.45%; p = 0.01) and a higher rate of abdominal operations (19.73% vs. 7.59%; p < 0.01) compared to below the ASIS. In contrast, CT ASBS below the ASIS was associated with a higher incidence of pelvic fractures (17.72% vs. 8.16%; p = 0.01) with fractures being an independent risk factor for abdominal injury requiring intervention. Logistic regression analyses and receiver-operator characteristic curves demonstrated ASBSI was significantly associated with abdominal injury requiring operative intervention.
Characteristics of abdominal wall injury on imaging such as location and contusion depth (ASBSI) are better predictors of abdominal operative need than standard clinical measures. This analysis substantiates a novel diagnostic tool which may have the potential to facilitate clinical diagnosis and management decisions in patients with abdominal seatbelt sign.
腹部安全带征（ASBS）与腹部损伤之间存在既定关联，但其定义仍不明确。我们推测与ASBS相关的特定影像学特征，如位于骨盆边缘上方的位置和腹壁挫伤深度，将能更好地预测潜在损伤以及手术干预的必要性。
我们对2010年至2015年在一级创伤中心接受评估的因机动车碰撞（MVC）而受约束的患者进行了回顾性病历审查。对CT影像进行审查，以确定是否存在与安全带使用相符的横向腹壁挫伤。根据髂前上棘（ASIS）确定挫伤位置。在挫伤水平测量腹壁厚度以及挫伤深度，并计算腹部安全带征深度指数（ASBSI）。
该队列的样本量为551名受试者。CT上ASBS位于ASIS上方的患者手术需求为19.73%，而仅有ASBS临床证据（CL ASBS）的患者手术需求为4.05%（p值<0.01）。与ASIS下方相比，ASIS上方的CT ASBS与更高的腹腔内损伤发生率（31.97%对16.45%；p = 0.01）和更高的腹部手术率（19.73%对7.59%；p < 0.01）相关。相比之下，ASIS下方的CT ASBS与更高的骨盆骨折发生率（17.72%对8.16%；p = 0.01）相关，骨折是需要干预的腹部损伤的独立危险因素。逻辑回归分析和受试者工作特征曲线表明，ASBSI与需要手术干预的腹部损伤显著相关。
影像学上腹壁损伤的特征，如位置和挫伤深度（ASBSI），比标准临床指标更能预测腹部手术需求。该分析证实了一种新型诊断工具，其可能有潜力促进对有腹部安全带征患者的临床诊断和管理决策。
