Division of Trauma, Burns, & Surgical Critical Care, University of California, Irvine, Orange, CA, USA.
Trauma Department, Scripps Memorial Hospital La Jolla, La Jolla, CA, USA.
Am Surg. 2024 Nov;90(11):2840-2847. doi: 10.1177/00031348241256084. Epub 2024 May 22.
The abdominal seat belt sign (SBS) is associated with an increased risk of hollow viscus injury (HVI). Older age is associated with worse outcomes in trauma patients. Thus, older trauma patients ≥65 years of age (OTPs) may be at an increased risk of HVI with abdominal SBS. Therefore, we hypothesized an increased incidence of HVI and mortality for OTPs vs younger trauma patients (YTPs) with abdominal SBS.
This post hoc analysis of a multi-institutional, prospective, observational study (8/2020-10/2021) included patients 18 years old with an abdominal SBS who underwent abdominal computed tomography (CT) imaging. Older trauma patients were compared to YTPs (18-64 years old) with bivariate analyses.
Of the 754 patients included in this study from nine level-1 trauma centers, there were 110 (14.6%) OTPs and 644 (85.4%) YTPs. Older trauma patients were older (mean 75.3 vs 35.8 years old, < .01) and had a higher mean Injury Severity Score (10.8 vs 9.0, = .02). However, YTPs had an increased abdominal abbreviated-injury scale score (2.01 vs 1.63, = .02). On CT imaging, OTPs less commonly had intraabdominal free fluid (21.7% vs 11.9%, = .02) despite a similar rate of abdominal soft tissue contusion ( > .05). Older trauma patients also had a statistically similar rate of HVI vs YTPs (5.5% vs 9.8%, = .15). Despite this, OTPs had increased mortality (5.5% vs 1.1%, < .01) and length of stay (LOS) (5.9 vs 4.9 days < .01).
Despite a similar rate of HVI, OTPs with an abdominal SBS had an increased rate of mortality and LOS. This suggests the need for heightened vigilance when caring for OTPs with abdominal SBS.
腹部安全带征（SBS）与空心内脏损伤（HVI）的风险增加有关。年龄较大与创伤患者的预后较差有关。因此，年龄较大的创伤患者（≥65 岁）可能会因腹部 SBS 而增加 HVI 的风险。因此，我们假设与年轻创伤患者（YTP）相比，腹部 SBS 的 OTP 会出现更高的 HVI 和死亡率。
这是一项多机构、前瞻性、观察性研究（2020 年 8 月至 2021 年 10 月）的事后分析，纳入了 18 岁以上伴有腹部 SBS 并接受腹部计算机断层扫描（CT）成像的患者。使用双变量分析比较了老年创伤患者与 YTP。
从 9 个 1 级创伤中心纳入本研究的 754 例患者中，有 110 例（14.6%）为 OTP，644 例（85.4%）为 YTP。老年创伤患者年龄较大（平均 75.3 岁比 35.8 岁，<0.01），损伤严重程度评分较高（10.8 比 9.0，=0.02）。然而，YTP 的腹部简明损伤量表评分较高（2.01 比 1.63，=0.02）。在 CT 成像上，尽管腹部软组织挫伤率相似（>0.05），但 OTP 较少出现腹腔游离液（21.7%比 11.9%，=0.02）。尽管如此，与 YTP 相比，老年创伤患者的 HVI 发生率无统计学差异（5.5%比 9.8%，=0.15）。尽管如此，OTP 的死亡率（5.5%比 1.1%，<0.01）和住院时间（LOS）（5.9 比 4.9 天，<0.01）更高。
尽管 HVI 发生率相似，但伴有腹部 SBS 的 OTP 死亡率和 LOS 更高。这表明在护理伴有腹部 SBS 的 OTP 时需要高度警惕。
