Delaplain et al evaluated patients with the abdominal seat belt sign for findings on abdominal CT associated with hollow viscus injury. These can help to identify which patients need further evaluation and which patients can be discharged safely. The authors are from multiple institutions in the United States.

Patient selection: vehicular accident with abdominal seat belt sign


Examination: high-resolution CT of abdomen and pelvis


Clinical findings associated with hollow viscus injury:

(1) hypotension

(2) temperature > 38°C

(3) abnormal serum lactate

(4) diffuse tenderness to palpation

(5) positive FAST scan

(6) guarding


The presence of free fluid has an odds ratio of 42.7 for hollow viscus injury.


Abnormalities on CT other than free fluid seen with hollow viscus injury:

(1) bowel wall thickening

(2) mesenteric stranding

(3) mesenteric hematoma

(4) free air


The negative CT scan is associated with an absence of hollow viscus injury (OR 41.1). All imaging tests negative was seen in 37% patients without hollow viscus injury vs 1.5% with.

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