The seatbelt sign is both a clinical and radiological sign. It is simply the presence of ecchymosis and/or abraded skin in the distribution of a seatbelt (i.e. horizontal and/or diagonal) extending across the abdomen evident after a motor vehicle accident.
A positive abdominal seatbelt sign, in combination with abdominal pain or tenderness, results in a higher likelihood of intra-abdominal injuries; some cohorts demonstrate a higher incidence of solid organ injuries 6 and others bowel/mesenteric injury 1,3. There exists little consensus regarding the significance of the specific (i.e. ecchymosis/abrasion) superficial injury present as it pertains to underlying injuries. CT of the abdomen/pelvis is highly sensitive in these patients for identifying significant intraabdominal injuries requiring exploratory laparotomy 6.
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- 2. Hayes CW, Conway WF, Walsh JW et-al. Seat belt injuries: radiologic findings and clinical correlation. Radiographics. 1991;11 (1): 23-36. doi:10.1148/radiographics.11.1.1996397 - Pubmed citation
- 3. Chandler CF, Lane JS, Waxman KS. Seatbelt sign following blunt trauma is associated with increased incidence of abdominal injury. Am Surg. 1997;63 (10): 885-8. Pubmed citation
- 4. Biswas S, Adileh M, Almogy G et-al. Abdominal injury patterns in patients with seatbelt signs requiring laparotomy. J Emerg Trauma Shock. 2014;7 (4): 295-300. doi:10.4103/0974-2700.142764 - Free text at pubmed - Pubmed citation
- 5. Bates DD, Wasserman M, Malek A, Gorantla V, Anderson SW, Soto JA, LeBedis CA. Multidetector CT of Surgically Proven Blunt Bowel and Mesenteric Injury. Radiographics : a review publication of the Radiological Society of North America, Inc. 37 (2): 613-625. doi:10.1148/rg.2017160092 - Pubmed
- 6. Shreffler J, Shreffler SA, Shreffler SM, Shreffler RA, Shreffler BJ, Shreffler NN, Shreffler HB, Shreffler HM, Shreffler. Patients with Abrasion or Ecchymosis Seat Belt Sign Have High Risk for Abdominal Injury, but Initial Computed Tomography is 100% Sensitive. (2020) The Journal of emergency medicine. doi:10.1016/j.jemermed.2020.06.057 - Pubmed