Abstract
Background
Children involved in motor vehicle crashes (MVC) can sustain bruising of the abdominal
wall associated with seat belt restraint. The incidence of bruising and its relationship
with significant intraabdominal injuries are not known.
Methods
An analysis of children involved in MVC between December 1998 and November 2002 was
performed, using the crash surveillance database from the Partners for Child Passenger
Safety (PCPS) project. Optimally (OR) or suboptimally (S-OR) restrained children aged
4 to 15 years were selected. The incidence of abdominal wall bruising was calculated
then correlated with the type of restraint as well as any intraabdominal injury with
an Abbreviated Injury Scale score ≥2.
Results
A total of 147,985 children in 102,548 crashes met study criteria. An abdominal bruise
was noted in 1.33% of the children (n = 1,967; 881 OR and 1,086 S-OR). Significant
intraabdominal injury was present in 309 children (0.21%, 95% CI 0.13 to 0.33), including
69 OR and 240 S-OR. The sensitivity, specificity, and positive and negative predictive
values of abdominal wall bruising for a significant intraabdominal injury were 73.5%,
98.8%, 11.5%, and 99.9%, respectively. Children with a bruise were substantially more
likely to have an intraabdominal injury than children without a bruise. (Odds Ratio
232.1, 95% CI, 75.9 to 710.3) Among those children with an abdominal bruise, 1% required
an abdominal operation (n = 20).
Conclusions
Abdominal wall bruising was relatively uncommon in both OR and S-OR children. Among
restrained children involved in MVC, those with a bruise were 232 times more likely
to have a significant intraabdominal injury when compared with those without a bruise.
It is imperative to pursue intraabdominal injury in children with a bruise of the
abdominal wall after MVC.
Keywords
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Article info
Footnotes
☆Dr Nicolas Lutz’s fellowship at the Children Hospital of Philadelphia was partially funded by SICPA and the Société Académique Vaudoise. Supported by State Farm through the Partners for Child Passenger Safety project.
Identification
Copyright
© 2004 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
