Title: Can you discharge a patient with seat belt sign?<br/>Author: Robert Flint<br/><a href='http://umem.org/profiles/faculty/2561/'>[Click to email author]</a><hr/><p dir="ltr" style="line-height: 1.38; margin-top: 9pt; margin-bottom: 9pt;">
<span style="font-family:times new roman,times,serif;"><span id="docs-internal-guid-5a17bd36-7fff-57b4-44b5-1e7232115fe9"><span style="font-size: 12pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;">Traditional trauma teaching is to admit trauma patients with abdominal wall ecchymosis caused by seat belts (seat belt sign) for fear of missing a hollow viscus injury leading to peritonitis and sepsis. </span></span></span></p>
<p dir="ltr" style="line-height:1.38;margin-top:9pt;margin-bottom:9pt;">
<span style="font-family:times new roman,times,serif;"><span id="docs-internal-guid-5a17bd36-7fff-57b4-44b5-1e7232115fe9"><span style="font-size: 12pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;">Over the past few years there have been studies pointing toward the safety of discharging blunt abdominal trauma patients with a negative CT even if they do have a seat belt sign.</span></span></span></p>
<p dir="ltr" style="line-height:1.38;margin-top:9pt;margin-bottom:9pt;">
<span style="font-family:times new roman,times,serif;"><span id="docs-internal-guid-5a17bd36-7fff-57b4-44b5-1e7232115fe9"><span style="font-size: 12pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;">In this most recent study, a negative CT was defined as </span></span></span></p>
<p dir="ltr" style="line-height:1.2;margin-top:9pt;margin-bottom:9pt;">
<span id="docs-internal-guid-5a17bd36-7fff-57b4-44b5-1e7232115fe9"><span style="font-size: 11pt; font-family: Arial; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;">1. No free fluid (free fluid was the leading indicator of occult hollow viscus injury)</span></span></p>
<p dir="ltr" style="line-height:1.2;margin-top:9pt;margin-bottom:9pt;">
<span id="docs-internal-guid-5a17bd36-7fff-57b4-44b5-1e7232115fe9"><span style="font-size: 11pt; font-family: Arial; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;">2. No solid organ injury</span></span></p>
<p dir="ltr" style="line-height:1.2;margin-top:9pt;margin-bottom:9pt;">
<span id="docs-internal-guid-5a17bd36-7fff-57b4-44b5-1e7232115fe9"><span style="font-size: 11pt; font-family: Arial; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;">3. No bowel wall irregular contours, thickening, hematoma or air</span></span></p>
<p dir="ltr" style="line-height:1.2;margin-top:9pt;margin-bottom:9pt;">
<span id="docs-internal-guid-5a17bd36-7fff-57b4-44b5-1e7232115fe9"><span style="font-size: 11pt; font-family: Arial; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;">4. No abdominal wall soft tissue contusion</span></span></p>
<p dir="ltr" style="line-height:1.2;margin-top:9pt;margin-bottom:9pt;">
<span id="docs-internal-guid-5a17bd36-7fff-57b4-44b5-1e7232115fe9"><span style="font-size: 11pt; font-family: Arial; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;">5. No mesenteric stranding or hematoma</span></span></p>
<p dir="ltr" style="line-height:1.2;margin-top:9pt;margin-bottom:9pt;">
<span id="docs-internal-guid-5a17bd36-7fff-57b4-44b5-1e7232115fe9"><span style="font-size: 11pt; font-family: Arial; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;">6. No bowel dilatation</span></span></p>
<p dir="ltr" style="line-height:1.2;margin-top:9pt;margin-bottom:9pt;">
<span style="font-family:times new roman,times,serif;"><span id="docs-internal-guid-5a17bd36-7fff-57b4-44b5-1e7232115fe9"><span style="font-size: 12pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;">If the patient’s CT did not include any of these findings, there was a 0.01% chance of finding a delayed hollow viscus injury. The authors conclude it is safe to discharge patients meeting these criteria. </span></span></span></p>
<p dir="ltr" style="line-height:1.2;margin-top:9pt;margin-bottom:9pt;">
<span style="font-family:times new roman,times,serif;"><span id="docs-internal-guid-5a17bd36-7fff-57b4-44b5-1e7232115fe9"><span style="font-size: 12pt; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;">If we include no rebound or guarding on physical exam along with a negative CT scan, it appears to be safe to discharge trauma patient’s with seat belt sign. </span></span></span></p>
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<fieldset><legend>References</legend>
<h1 dir="ltr" style="line-height:1.56;margin-top:5pt;margin-bottom:8pt;">
<span id="docs-internal-guid-14f40aac-7fff-a8bd-c855-0c708272d68f"><a href="https://jamanetwork.com/searchresults?author=Patrick+T.+Delaplain&q=Patrick+T.+Delaplain" style="text-decoration-line: none;"><span style="font-size: 12pt; font-family: Arial; color: rgb(0, 0, 0); font-weight: 400; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;">Patrick T. Delaplain, MD</span></a><font color="#000000" size="1">,</font><span style="font-size: 12pt; font-family: Arial; font-weight: 400; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;"> </span><a href="https://jamanetwork.com/searchresults?author=Erika+Tay-Lasso&q=Erika+Tay-Lasso" style="text-decoration-line: none;"><span style="font-size: 12pt; font-family: Arial; color: rgb(0, 0, 0); font-weight: 400; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;">Erika Tay-Lasso, MD</span></a><span style="font-size: 12pt; font-family: Arial; font-weight: 400; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;">; </span><a href="https://jamanetwork.com/searchresults?author=Walter+L.+Biffl&q=Walter+L.+Biffl" style="text-decoration-line: none;"><span style="font-size: 12pt; font-family: Arial; color: rgb(0, 0, 0); font-weight: 400; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;">Walter L. Biffl, MD</span></a><span style="font-size: 12pt; font-family: Arial; font-weight: 400; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;">; </span><span style="font-size: 12pt; font-family: Arial; font-weight: 400; font-variant-numeric: normal; font-variant-east-asian: normal; text-decoration-line: underline; text-decoration-skip-ink: none; vertical-align: baseline; white-space: pre-wrap;">et al</span><span style="font-size: 12pt; font-family: Arial; font-weight: 400; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;"> </span></span></h1>
<h1 dir="ltr" style="line-height:1.56;margin-top:5pt;margin-bottom:8pt;">
<span id="docs-internal-guid-14f40aac-7fff-a8bd-c855-0c708272d68f"><span style="font-size: 12pt; font-family: Arial; font-weight: 400; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;">Excluding Hollow Viscus Injury for Abdominal Seat Belt Sign Using Computed Tomography </span></span></h1>
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<span class="meta-citation-journal-name" font-size:="" guardian="" helvetica="" style="box-sizing: inherit; font-style: italic; color: rgb(51, 51, 51); font-family: " textsans="">JAMA Surg. </span><span class="meta-citation" font-size:="" guardian="" helvetica="" style="box-sizing: inherit; color: rgb(51, 51, 51); font-family: " textsans="">2022;157(9):771-778</span></h1>
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