Division of Trauma, Burns, & Surgical Critical Care, University of California, Irvine.
Trauma Department, Scripps Memorial Hospital La Jolla, La Jolla, California.
JAMA Surg. 2022 Sep 1;157(9):771-778. doi: 10.1001/jamasurg.2022.2770.
Abdominal seat belt sign (SBS) has historically entailed admission and observation because of the diagnostic limitations of computed tomography (CT) imaging and high rates of hollow viscus injury (HVI). Recent single-institution, observational studies have questioned the utility of this practice.
To evaluate whether a negative CT scan can safely predict the absence of HVI in the setting of an abdominal SBS.
DESIGN, SETTING, AND PARTICIPANTS: This prospective, observational cohort study was conducted in 9 level I trauma centers between August 2020 and October 2021 and included adult trauma patients with abdominal SBS.
Inclusion in the study required abdominal CT as part of the initial trauma evaluation and before any surgical intervention, if performed. Results of CT scans were considered positive if they revealed any of the following: abdominal wall soft tissue contusion, free fluid, bowel wall thickening, mesenteric stranding, mesenteric hematoma, bowel dilation, pneumatosis, or pneumoperitoneum.
Presence of HVI diagnosed at the time of operative intervention.
A total of 754 patients with abdominal SBS had an HVI prevalence of 9.2% (n = 69), with only 1 patient with HVI (0.1%) having a negative CT (ie, none of the 8 a priori CT findings). On bivariate analysis comparing patients with and without HVI, there were significant associations between each of the individual CT scan findings and the presence of HVI. The strongest association was found with the presence of free fluid, with a more than 40-fold increase in the likelihood of HVI (odds ratio [OR], 42.68; 95% CI, 20.48-88.94; P < .001). The presence of free fluid also served as the most effective binary classifier for presence of HVI (area under the receiver operator characteristic curve [AUC], 0.87; 95% CI, 0.83-0.91). There was also an association between a negative CT scan and the absence of HVI (OR, 41.09; 95% CI, 9.01-727.69; P < .001; AUC, 0.68; 95% CI, 0.66-0.70).
The prevalence of HVI among patients with an abdominal SBS and negative findings on CT is extremely low, if not zero. The practice of admitting and observing all patients with abdominal SBS should be reconsidered when a high-quality CT scan is negative, which may lead to significant resource and cost savings.
腹部安全带征（SBS）历史上需要住院观察，因为 CT 成像的诊断局限性以及空腔内脏器损伤（HVI）的发生率很高。最近的单机构观察性研究对这种做法的实用性提出了质疑。
评估在 SBS 存在的情况下，阴性 CT 扫描是否可以安全预测 HVI 的缺失。
设计、地点和参与者：这项前瞻性观察队列研究在 2020 年 8 月至 2021 年 10 月期间在 9 个一级创伤中心进行，纳入了有 SBS 的成人创伤患者。
纳入研究需要进行腹部 CT 作为初始创伤评估的一部分，如果进行手术干预，则在手术前进行。如果 CT 扫描显示以下任何一种情况，则认为结果为阳性：腹壁软组织挫伤、游离液、肠壁增厚、肠系膜绞索、肠系膜血肿、肠扩张、气肿或气腹。
手术干预时诊断的 HVI 存在。
共有 754 例 SBS 患者，HVI 的患病率为 9.2%（n=69），只有 1 例 HVI 患者（0.1%）的 CT 扫描为阴性（即 8 种预先设定的 CT 发现均无阳性）。在比较有和无 HVI 的患者的单变量分析中，每个 CT 扫描发现与 HVI 的存在均存在显著关联。最强的关联是游离液的存在，HVI 的可能性增加了 40 多倍（优势比[OR]，42.68；95%CI，20.48-88.94；P<0.001）。游离液的存在也是预测 HVI 存在的最有效二进制分类器（接受者操作特征曲线下面积[AUC]，0.87；95%CI，0.83-0.91）。阴性 CT 扫描与 HVI 缺失之间也存在关联（OR，41.09；95%CI，9.01-727.69；P<0.001；AUC，0.68；95%CI，0.66-0.70）。
SBS 患者 CT 扫描结果阴性且 HVI 发生率极低，甚至为零。当高质量 CT 扫描为阴性时，应重新考虑对所有 SBS 患者进行住院观察，这可能会带来显著的资源和成本节约。
