Citation

Eberhardt CS, Zand T, Ceroni D, Wildhaber BE, La Scala G. Pediatr. Emerg. Care 2015; 32(5): 318-322.

Affiliation

From the *Divisions of General Pediatrics, †Pediatric Radiology, ‡Pediatric Orthopedics, and §Pediatric Surgery, Department of Pediatrics, University Hospital Geneva, Geneva, Switzerland.

Copyright

(Copyright © 2015, Lippincott Williams and Wilkins)

DOI

10.1097/PEC.0000000000000527

PMID

26087444

Abstract

The seatbelt syndrome represents an injury pattern seen after motor vehicle accidents. It is secondary to either the misplacement of seatbelts over the abdomen or the misuse of the restraint systems. This syndrome is infrequent in the pediatric population and occurs mostly in school-aged children because recommended lap-shoulder belts and booster seats are often not used in this age group, so that the seatbelt lies over the abdomen. Sudden deceleration bends the child around the lap belt causing injuries to the viscera, head, and spine (Chance fracture), often associated with paraplegia. Because not all patients have an abdominal seatbelt sign, this syndrome can easily not be recognized with potentially life-threatening consequences. We report on 3 patients with the seatbelt syndrome and review the literature regarding prevalence, diagnosis, treatment, and prognosis of the different injuries and discuss the diagnostic challenges of intestinal lesions and their management. Following this accident pattern, in hemodynamically stable patients with a normal abdominal computed tomography scan, close surveillance is warranted to rule out intestinal lesions manifesting with progressive peritoneal irritation. In hemodynamically unstable patients, or if there is evidence of free air on the computed tomography scan, emergency abdominal exploration is required.

Language: en