Incidence and clinical significance of abdominal wall bruising in restrained children involved in motor vehicle crashes.

TitleIncidence and clinical significance of abdominal wall bruising in restrained children involved in motor vehicle crashes.
Publication TypeJournal Article
Year of Publication2004
AuthorsLutz N, Nance ML, Kallan MJ, Arbogast KB, Durbin D, Winston FK
JournalJ Pediatr Surg
Volume39
Issue6
Pagination972-5
Date Published2004 Jun
ISSN1531-5037
KeywordsAbdominal Injuries, Abdominal Wall, Accidents, Traffic, Adolescent, Child, Child, Preschool, Contusions, Databases, Factual, Female, Humans, Incidence, Infant Equipment, Male, Motor Vehicles, Philadelphia, Retrospective Studies, Seat Belts
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 > or =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.

Alternate JournalJ. Pediatr. Surg.
PubMed ID15185237