Olga Achildi1, Randal R Betz, Harsh Grewal. 1. Section of Pediatric Surgery, Department of Surgery, Temple University School of Medicine and Temple University Children's Medical Center, Philadelphia, Pennsylvania 19140, USA.
Abstract
BACKGROUND/ OBJECTIVE: Approximately 250,000 patients are presently living with spinal cord injury (SCI) in the United States. Approximately 20% of patients with SCI are less than 20 years old, and 15% are less than 15 years old. The most common cause of pediatric SCI is a motor vehicle collision (MVC; approximately 40%); lapbelt injuries and the seatbelt syndrome are seen more often in children involved in MVCs. METHODS: A search and analysis of current literature on lapbelt injuries, seatbelt syndrome, and pediatric SCI using PubMed. RESULTS: Children involved in MVCs who are improperly restrained are at higher risk of sustaining injuries. The risk of significant intra-abdominal injuries is increased almost fourfold in these children. Presence of abdominal wall ecchymosis (AWE) was associated with intra-abdominal injuries in up to 84% of children, with hollow viscus injury being the most common. Likewise, presence of AWE is associated with vertebral fractures, including Chance fractures, in up to 50% of patients. Vertebral fractures were associated with SCI in up to 11%. The presence of AWE in an improperly restrained child should warrant a thorough search for intra-abdominal injuries, vertebral fractures, and SCI. CONCLUSIONS: Lapbelt injuries and the seatbelt syndrome are often associated with pediatric SCI in improperly restrained children. This injury complex and its associated abdominal injuries are difficult to diagnose unless a high index of suspicion is maintained; delay in diagnosis increases morbidity, and early surgical intervention should be considered.
BACKGROUND/ OBJECTIVE: Approximately 250,000 patients are presently living with spinal cord injury (SCI) in the United States. Approximately 20% of patients with SCI are less than 20 years old, and 15% are less than 15 years old. The most common cause of pediatric SCI is a motor vehicle collision (MVC; approximately 40%); lapbelt injuries and the seatbelt syndrome are seen more often in children involved in MVCs. METHODS: A search and analysis of current literature on lapbelt injuries, seatbelt syndrome, and pediatric SCI using PubMed. RESULTS:Children involved in MVCs who are improperly restrained are at higher risk of sustaining injuries. The risk of significant intra-abdominal injuries is increased almost fourfold in these children. Presence of abdominal wall ecchymosis (AWE) was associated with intra-abdominal injuries in up to 84% of children, with hollow viscus injury being the most common. Likewise, presence of AWE is associated with vertebral fractures, including Chance fractures, in up to 50% of patients. Vertebral fractures were associated with SCI in up to 11%. The presence of AWE in an improperly restrained child should warrant a thorough search for intra-abdominal injuries, vertebral fractures, and SCI. CONCLUSIONS: Lapbelt injuries and the seatbelt syndrome are often associated with pediatric SCI in improperly restrained children. This injury complex and its associated abdominal injuries are difficult to diagnose unless a high index of suspicion is maintained; delay in diagnosis increases morbidity, and early surgical intervention should be considered.
Authors: M B Bracken; M J Shepard; T R Holford; L Leo-Summers; E F Aldrich; M Fazl; M Fehlings; D L Herr; P W Hitchon; L F Marshall; R P Nockels; V Pascale; P L Perot; J Piepmeier; V K Sonntag; F Wagner; J E Wilberger; H R Winn; W Young Journal: JAMA Date: 1997-05-28 Impact factor: 56.272
Authors: Michael L Nance; Nicolas Lutz; Kristy B Arbogast; Rebecca A Cornejo; Michael J Kallan; Flaura K Winston; Dennis R Durbin Journal: Ann Surg Date: 2004-01 Impact factor: 12.969
Authors: Nicolas Lutz; Michael L Nance; Michael J Kallan; Kristy B Arbogast; Dennis R Durbin; Flaura K Winston Journal: J Pediatr Surg Date: 2004-06 Impact factor: 2.545
Authors: Anujaianthi Kuzhandaivel; Andrea Nistri; Graciela L Mazzone; Miranda Mladinic Journal: Front Cell Neurosci Date: 2011-06-17 Impact factor: 5.505