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