A Negative CT May Be Sufficient to Safely Discharge Patients with Abdominal Seatbelt Sign from The Emergency Department: A Case Series Analysis

ABSTRACTBACKGROUNDThe presence of an abdominal seatbelt sign (ASBS) following a motor vehicle collision (MVC) is associated with a high risk for occult intraabdominal injury, prompting imaging studies and a prolonged period of clinical observation. The aim of this study was to determine how a negative computerized tomography (CT) of the abdomen/pelvis (A/P) can serve in the safe disposition of these patients. Our hypothesis was that in the setting of a negative CT, the presence of occult intra-abdominal injuries requiring a delayed intervention is extremely unlikely.METHODSThe medical charts of patients admitted from 01/2014 to 12/2016 to a Level I Trauma Center following a MVC were reviewed for a documentation of an ASBS. Patients who did not have a CT A/P upon admission were excluded. The CT A/P of the remaining patients were then classified as negative if there were no findings of acute vascular, visceral or bony injury or positive if any of these findings was present. The sensitivity, specificity, positive (PPV) and negative predictive value (NPV) of CT A/P for the presence of an intraabdominal injury were calculated.RESULTSOver the 3-year study period, 1,108 patients were admitted after a MVC. Of those, 196 (17.7%) had an ASBS upon presentation and 183/196 (93.4%) underwent a CT A/P. A total of 114/183 (62.3%) had a negative CT A/P. These patients remained hospitalized for a median of 2 (1-35) days with none (0.0%) requiring a delayed laparotomy. The sensitivity of CT A/P in identifying patients requiring an exploratory laparotomy was 100.0%, specificity was 67.9%, NPV was 100.0%, and PPV was 21.7%. The negative likelihood ratio was 0.00.CONCLUSIONFor patients with an ASBS following a MVC, a negative CT A/P may be sufficient for safe discharge from the emergency department without any need for additional clinical observation.Type of studyPrognostic, clinicalLevel of evidenceIII BACKGROUND The presence of an abdominal seatbelt sign (ASBS) following a motor vehicle collision (MVC) is associated with a high risk for occult intraabdominal injury, prompting imaging studies and a prolonged period of clinical observation. The aim of this study was to determine how a negative computerized tomography (CT) of the abdomen/pelvis (A/P) can serve in the safe disposition of these patients. Our hypothesis was that in the setting of a negative CT, the presence of occult intra-abdominal injuries requiring a delayed intervention is extremely unlikely. METHODS The medical charts of patients admitted from 01/2014 to 12/2016 to a Level I Trauma Center following a MVC were reviewed for a documentation of an ASBS. Patients who did not have a CT A/P upon admission were excluded. The CT A/P of the remaining patients were then classified as negative if there were no findings of acute vascular, visceral or bony injury or positive if any of these findings was present. The sensitivity, specificity, positive (PPV) and negative predictive value (NPV) of CT A/P for the presence of an intraabdominal injury were calculated. RESULTS Over the 3-year study period, 1,108 patients were admitted after a MVC. Of those, 196 (17.7%) had an ASBS upon presentation and 183/196 (93.4%) underwent a CT A/P. A total of 114/183 (62.3%) had a negative CT A/P. These patients remained hospitalized for a median of 2 (1-35) days with none (0.0%) requiring a delayed laparotomy. The sensitivity of CT A/P in identifying patients requiring an exploratory laparotomy was 100.0%, specificity was 67.9%, NPV was 100.0%, and PPV was 21.7%. The negative likelihood ratio was 0.00. CONCLUSION For patients with an ASBS following a MVC, a negative CT A/P may be sufficient for safe discharge from the emergency department without any need for additional clinical observation. Type of study Prognostic, clinical Level of evidence III The authors have no conflicts of interest to report and have received no financial support in relation to this manuscript. Correspondence to: Galinos Barmparas, MD, Assistant Professor of Surgery, Cedars-Sinai Medical Center, Department of Surgery, 8635 W. 3rd Street – Suite 650W, Los Angeles, CA 90048, E-mail: Galinos.Barmparas@cshs.org © 2018 Lippincott Williams & Wilkins, Inc.

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