seatbelts.ppt

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  • Cornwell EE, Velmahos GC, Berne TV, et al: The fate of colonic suture lines in high-risk trauma patients: a prospective analysis. J Am Coll Surg 187:58, 1998.
  • New York first state with seatbelt law. Currently, only New Hampshire does not have a seatbelt law. Massachusetts has only a secondary law. Usage rates increase as you move West.
  • Denis, et al. “Changing Trends with Abdominal Injury in Seatbelt Wearers.” J Trauma . 1983, 23(11):1007. University of Montreal. Mandatory seatbelt law in Canada, 1 January 1971. Porter, et al. “Patterns of Injury in Belted and Unbelted Individuals Presenting to a Trauma Center After Motor Vehicle Crash: Seat Belt Syndrome Revisited.”
  • Chandler CF, Lane JS, Waxman KS. Seatbelt sign following blunt trauma is associated with increased incidence of abdominal injury. Am Surg . 1997 Oct;63(10):885-8. 117 adult MVC patients.
  • seatbelts.ppt

    1. 1. Trauma: Case Presentation Ronald Jou 19 March 2007
    2. 2. Ring Down <ul><li>7  year-old girl </li></ul><ul><li>Rear passenger </li></ul><ul><li>Lap belt restraint (shared) </li></ul><ul><li>Car traveling at freeway speeds </li></ul><ul><li>Tire blew out </li></ul><ul><li>Impact on median divider </li></ul>
    3. 3. Trauma Survey <ul><li>1 ° survey: </li></ul><ul><ul><li>Patient vomiting </li></ul></ul><ul><ul><li>No life-threatening injuries </li></ul></ul><ul><li>Vitals stable </li></ul><ul><li>Hx of abd pain and vomiting that AM </li></ul><ul><li>No medication allergies or PMHx </li></ul><ul><li>Patient had no complaints </li></ul>
    4. 4. Trauma Survey <ul><li>2 ° survey: </li></ul><ul><ul><li>Abdomen soft, non-tender </li></ul></ul><ul><ul><li>Abrasion over left iliac crest </li></ul></ul><ul><li>Repeat survey: </li></ul><ul><ul><li>Somnolent </li></ul></ul><ul><ul><li>CT head: negative </li></ul></ul><ul><ul><li>Patient admitted to PICU </li></ul></ul>
    5. 5. PICU Course <ul><li>Linear bruising across abdomen </li></ul><ul><li>Abdominal pain and tenderness </li></ul><ul><li>CT abdomen/pelvis obtained </li></ul>
    6. 13. Operating Theater <ul><li>Diagnostic laparoscopy: </li></ul><ul><ul><li>Moderate stool </li></ul></ul><ul><ul><li>Mild blood </li></ul></ul><ul><ul><li>Sigmoid perforation </li></ul></ul><ul><ul><li>Conversion to open laparotomy </li></ul></ul>
    7. 14. Operating Theater <ul><li>Exploratory laparotomy: </li></ul><ul><ul><li>Full thickness sigmoid perforation </li></ul></ul><ul><ul><li>No other injuries seen </li></ul></ul><ul><ul><li>Six hours had elapsed since injury </li></ul></ul>
    8. 16. Operating Theater <ul><li>Treatment: </li></ul><ul><ul><li>Resection of injury </li></ul></ul><ul><ul><li>Loop sigmoid colostomy </li></ul></ul>
    9. 17. Seatbelts <ul><li>Sir George Cayley, ca. 1800 </li></ul><ul><li>Implemented in aircraft, 1930s </li></ul><ul><li>Standard for U.S. automobiles, 1964 </li></ul><ul><li>Rear belts standard in U.S., 1968 </li></ul>
    10. 18. Seatbelt Innovations <ul><li>Three-point belt, 1958 </li></ul><ul><li>Vehicle sensors </li></ul><ul><li>Pretensioners, 1981 </li></ul><ul><li>Webclamps </li></ul><ul><li>Rip-stitching </li></ul>
    11. 19. U.S. Seatbelt Usage Rates 75% 2003 50% 1990 15% 1984 10% 1980 Usage rate Year
    12. 20. Please Wear Your Seatbelt <ul><li>No randomized controlled trials </li></ul><ul><li>Only cohort data is available </li></ul><ul><li>Seatbelt laws reduce fatality by 7-10% </li></ul>
    13. 21. Patterns of Injury <ul><li>Severe head injury </li></ul><ul><li>Facial injury </li></ul><ul><li>Solid organ injury </li></ul><ul><li>Long-bone fracture </li></ul><ul><li>Hollow viscus injury </li></ul><ul><li>Sternal fracture </li></ul><ul><li>Lumbar spine </li></ul>
    14. 22. “Seatbelt Sign” <ul><li>Linear ecchymosis of the abdominal wall </li></ul>
    15. 24. “Seatbelt Sign” <ul><li>Seen in 60% of 112 adults in MVC </li></ul><ul><ul><li>64% v. 9% had abdominal injury </li></ul></ul><ul><ul><li>36% v. 4% required operation </li></ul></ul><ul><ul><li>35% v. 3% had hollow viscus injury </li></ul></ul>
    16. 25. “Seatbelt Sign” <ul><li>MVCs in EAST multi-institutional study </li></ul><ul><ul><li>4.7-fold increase in small bowel perforation in MVCs. </li></ul></ul>
    17. 26. Problem <ul><li>Seatbelt injuries are difficult to diagnose </li></ul><ul><li>No ideal diagnostic test </li></ul><ul><li>Delays in diagnosis lead to morbidity </li></ul>
    18. 27. Solution <ul><li>Patients with seatbelt sign need workup </li></ul><ul><ul><li>CT abdomen/pelvis </li></ul></ul><ul><ul><li>Serial examinations </li></ul></ul><ul><ul><li>DPL </li></ul></ul>
    19. 28. Questions <ul><li>Chest seatbelt sign? </li></ul><ul><li>Does an abrasion count? </li></ul><ul><li>Safer seatbelts? </li></ul><ul><li>Increasing usage in high-risk groups? </li></ul>

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