Prevalence of intra-abdominal injury among patients with seatbelt signs, a systematic review and meta-analysis

Authors

Ali Pourmand, Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States. Electronic address: Pourmand@gwu.edu.
Emily Terrebonne, Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
Vadym Shapovalov, Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
Susan Kartiko, Department of Surgery, The George Washington University School of Medicine & Health Sciences, Washington, DC, United States.
Rashed AlRemeithi, Department of Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
Quincy K. Tran, Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, United States; Program in Trauma, The R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, Baltimore, MD, United States.

Document Type

Journal Article

Publication Date

12-3-2023

Journal

The American journal of emergency medicine

Volume

76

DOI

10.1016/j.ajem.2023.11.058

Keywords

Abdominal imaging; Abdominal seat belt sign; Intra-abdominal injury; Seat belt sign; Surgical intervention

Abstract

INTRODUCTION: The advancement of seat belts have been essential to reducing morbidity and mortality related to motor vehicle collisions (MVCs). The "seat belt sign" (SBS) is an important physical exam finding that has guided management for decades. This study, comprising a systematic review and random-effects meta-analysis, asses the current literature for the likelihood of the SBS relating to intra-abdominal injury and surgical intervention. METHODS: PubMed and Scopus databases were searched from their beginnings through August 4, 2023 for eligible studies. Outcomes included the prevalence of intra-abdominal injury and need for surgical intervention. Cochrane's Risk of Bias (RoB) tool and the Newcastle-Ottawa Scale (NOS) were applied to assess risk of bias and study quality; Q-statistics and I values were used to assess for heterogeneity. RESULTS: The search yielded nine observational studies involving 3050 patients, 1937 (63.5%) of which had a positive SBS. The pooled prevalence of any intra-abdominal injury was 0.42, (95% CI 0.28-0.58, I = 96%) The presence of a SBS was significantly associated with increased odds of intra-abdominal injury (OR 3.62, 95% CI 1.12-11.6, P = 0.03; I = 89%), and an increased likelihood of surgical intervention (OR 7.34, 95% CI 2.03-26.54, P < 0.001; I = 29%). The measurement for any intra-abdominal injury was associated with high heterogeneity, I = 89%. CONCLUSION: This meta-analysis suggests that the presence of a SBS was associated with a statistically significant higher likelihood of intra-abdominal injury and need for surgical intervention. The study had high heterogeneity, likely due to the technological advancements over the course of this study, including seat belt design and diagnostic imaging sensitivity. Further studies with more recent data are needed to confirm these results.

APA Citation

Pourmand, Ali; Terrebonne, Emily; Shapovalov, Vadym; Kartiko, Susan; AlRemeithi, Rashed; and Tran, Quincy K., "Prevalence of intra-abdominal injury among patients with seatbelt signs, a systematic review and meta-analysis" (2023). GW Authored Works. Paper 4017.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/4017

Department

Emergency Medicine