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Abstract：
OBJECTIVE: We analyzed our series of patients with seatbelt signs (bruising) that underwent laparotomy in order to correlate injury pattern with clinical course and outcome.
METHODS: Retrospective analysis of patients with seatbelt signs presenting to the level 1 Trauma Unit between 2005 and 2010 was performed. We evaluated the nature of injuries during laparotomy associated with seatbelt signs and their treatment and complications.
RESULTS: There were 41 patients, 25 (61%) male, with a median age of 26 years. Median injury severity score (ISS) was 25 (range 6-66) and overall mortality was 10% (four patients). Patients were classified into three groups according to time from injury to surgery. Median time to surgery for the immediate group (n = 12) was 1.05 h, early group (n = 22) was 2.7 h, and delayed group (n = 7) was 19.5 h. Patients in the immediate group tended to have solid organ injuries; whereas, patients in the delayed group had bowel injury. Patients with solid organ injuries were found to be more seriously injured and had higher mortality (P < 0.01) and morbidity compared with patients with the \"classic\" bowel injury pattern associated with a typical seatbelt sign.
CONCLUSIONS: Our data suggest that there is a cohort of patients with seatbelt injury who have solid organ injury requiring urgent intervention. Solid organ injuries associated with malpositioned seatbelts lying higher on the abdomen tend to result in hemodynamic instability necessitating immediate surgery. They have more postoperative complications and a greater mortality. Seatbelt signs should be accurately documented after any car crash.
METHODS: Retrospective analysis of patients with seatbelt signs presenting to the level 1 Trauma Unit between 2005 and 2010 was performed. We evaluated the nature of injuries during laparotomy associated with seatbelt signs and their treatment and complications.
RESULTS: There were 41 patients, 25 (61%) male, with a median age of 26 years. Median injury severity score (ISS) was 25 (range 6-66) and overall mortality was 10% (four patients). Patients were classified into three groups according to time from injury to surgery. Median time to surgery for the immediate group (n = 12) was 1.05 h, early group (n = 22) was 2.7 h, and delayed group (n = 7) was 19.5 h. Patients in the immediate group tended to have solid organ injuries; whereas, patients in the delayed group had bowel injury. Patients with solid organ injuries were found to be more seriously injured and had higher mortality (P < 0.01) and morbidity compared with patients with the \"classic\" bowel injury pattern associated with a typical seatbelt sign.
CONCLUSIONS: Our data suggest that there is a cohort of patients with seatbelt injury who have solid organ injury requiring urgent intervention. Solid organ injuries associated with malpositioned seatbelts lying higher on the abdomen tend to result in hemodynamic instability necessitating immediate surgery. They have more postoperative complications and a greater mortality. Seatbelt signs should be accurately documented after any car crash.
摘要：
目的：我们分析了一系列有安全带征象（瘀伤）的剖腹手术患者，以便将损伤模式与临床病程和结果相关联。
方法：对2005年至2010年出现1级创伤单元安全带征象的患者进行回顾性分析。我们评估了与安全带体征相关的剖腹手术损伤的性质及其治疗和并发症。
结果：有41例患者，25（61%）男性，平均年龄为26岁。中位损伤严重程度评分（ISS）为25（范围6-66），总死亡率为10％（4例）。根据从损伤到手术的时间将患者分为三组。立即组（n=12）的中位手术时间为1.05h，早期组（n=22）2.7h，延迟组（n=7）为19.5h。直接组的患者倾向于实体器官损伤；延迟组患者出现肠损伤.与典型的安全带征相关的“经典”肠损伤模式的患者相比，实体器官损伤的患者受伤更为严重，死亡率更高（P<0.01）和发病率。
结论：我们的数据表明，有一组患有安全带损伤的患者患有实体器官损伤，需要紧急干预。与腹部较高位置的安全带错位相关的实体器官损伤往往会导致血液动力学不稳定，因此需要立即手术。他们有更多的术后并发症和更高的死亡率。发生任何车祸后，应准确记录安全带标志。
方法：对2005年至2010年出现1级创伤单元安全带征象的患者进行回顾性分析。我们评估了与安全带体征相关的剖腹手术损伤的性质及其治疗和并发症。
结果：有41例患者，25（61%）男性，平均年龄为26岁。中位损伤严重程度评分（ISS）为25（范围6-66），总死亡率为10％（4例）。根据从损伤到手术的时间将患者分为三组。立即组（n=12）的中位手术时间为1.05h，早期组（n=22）2.7h，延迟组（n=7）为19.5h。直接组的患者倾向于实体器官损伤；延迟组患者出现肠损伤.与典型的安全带征相关的“经典”肠损伤模式的患者相比，实体器官损伤的患者受伤更为严重，死亡率更高（P<0.01）和发病率。
结论：我们的数据表明，有一组患有安全带损伤的患者患有实体器官损伤，需要紧急干预。与腹部较高位置的安全带错位相关的实体器官损伤往往会导致血液动力学不稳定，因此需要立即手术。他们有更多的术后并发症和更高的死亡率。发生任何车祸后，应准确记录安全带标志。
