Pediatric emergency medicine trisk 3199 3199

LAP AND SHOULDER BELT AND AIR BAG INJURIES
Children restrained only by lap belts in motor vehicles involved in rapid
deceleration crashes are at risk to sustain intra-abdominal injuries as well as
injuries to the lumbar spine. The “seat belt syndrome or complex” refers to the
triad of abdominal wall bruising, internal abdominal injury, and spinal fracture
(the so-called “Chance fractures” due to compression or flexion–distraction
fractures of the lumbar spine). In turn, as many as 50% of children with Chance
fractures have intra-abdominal injuries, including duodenal perforation,
mesenteric disruption, transection of small bowel, pancreatic injury, and bladder
rupture ( Fig. 103.8 ). Therefore, a high index of suspicion must be maintained to
detect such injuries. The hallmark of the lap belt complex is abdominal or flank
ecchymosis in the pattern of a strap or belt ( Fig. 103.9 ). This is accompanied by
abdominal and back pain. A normal abdominal CT scan does not rule out
ruptured viscus, and laparoscopy or laparotomy should be considered for children
in whom the lap belt complex is suspected strongly ( Figs. 103.10 and 103.11 ).
Carotid injuries caused by high-riding shoulder restraints in motor vehicle
collisions are much less common. Consideration should be given for CT
angiography of the neck vessels if there is evidence of significant neck contusion
or trauma.