Lap belt injury can be more severe than it appears

NEW YORK (Reuters Health) - Lap belt injuries and the "seatbelt syndrome" are often associated with spinal cord injuries in children who have been improperly restrained when involved in a car accident, according to a study in the Journal of Spinal Cord Medicine.

The seatbelt syndrome refers to a cluster of injuries that can involve the spine and abdomen, which may often initially appear to be minor. The syndrome may include rupture of organs in the abdomen or pelvis, injuries to major blood vessels, and fractures of the spine, ribs, sternum or clavicle.

Bruising of the abdominal wall in a child restrained with a lap belt during a motor vehicle accident "should warrant a search for other injuries, including spinal cord injury, vertebral fractures, and intra-abdominal injuries," write Dr. Harsh Grewal, of Temple University Children's Medical Center, Philadelphia, and colleagues.

The researchers reviewed 10 years of published studies on motor vehicle accidents and children. In an analysis of children with spinal fractures, they found that 40 percent had abdominal wall bruising and 46 percent had internal abdominal injuries.

Abdominal wall bruising was associated with vertebral fractures in up to 50 percent of patients. A clear association was also found between spinal fractures and spinal cord injury.

"Although the most common findings are intra-abdominal injuries, the consequence of a missed spinal cord injury can be devastating," the investigators warn.

"This injury complex and its associated abdominal injuries are difficult to diagnose unless a high index of suspicion is maintained," they add. Because a delayed diagnosis increases the risk of serious damage, surgery should be considered for these patients, they conclude.

SOURCE: Journal of Spinal Cord Medicine, August 2007.