Abdominal Seat Belt Sign Is Associated with Similar Incidence of Hollow Viscus Injury but Increased Mortality in Trauma in Patients 65 Years and Older: A PCSA Multicenter Study

Abstract

INTRODUCTION: The abdominal seat belt sign (A-SBS) is associated with increased risk of hollow viscus injury (HVI). Previous studies have shown that older age is associated with worse outcomes in trauma patients. Older adults (65 years or older) may be at increased risk of HVI with A-SBS. Hence, we hypothesized that HVI and mortality is increased in OAs compared with younger patients (younger than 65 years) with A-SBS. METHODS: This multi-institutional, prospective, observational study (August 2020 to October 2021) included patients 18 years or older with an A-SBS who underwent abdominal CT imaging. No patients were excluded. OAs were compared with younger trauma patients with bivariate analyses. RESULTS: There were 754 patients (110 OAs; 644 younger) included from 9 Level I trauma centers. OAs presented with a higher mean injury severity score (10.8 vs 9.0; p = 0.02), although the younger cohort presented with a higher abdominal abbreviated-injury scale score (2.01 vs 1.63; p = 0.02). On CT imaging, OAs were less likely to present with intra-abdominal free fluid (21.7% vs 11.9%; p = 0.02; Table) despite a similar rate of abdominal soft tissue contusion (p > 0.05). Although HVI was comparable in both groups (5.5% vs 9.8%; p =0.15), OAs experienced increased mortality (5.5% vs 1.1%; p < 0.01) and length of stay (5.9 vs 4.9 days; p < 0.01). Table. - Patient Demographics and Presentation Demographics/Presentation Younger (<65) Older Adults (≥65) p Value Age, mean (SD) 35.8 (13.9) 75.3 (7.0) <0.01 Injury Severity Score, mean (SD) 9.0 (8.2) 10.8 (8.8) 0.02 Abdomen Abbreviated Injury Scale, mean (SD) 2.01 (1.09) 1.63 (0.79) 0.02 Glasgow Coma Scale, mean (SDs) 14.6 (1.5) 14.6 (1.6) 0.73 Positive Fast Scan, n (%) 29 (4.5) 7 (6.4) 0.40 Soft Tissue Seat Belt Sign, n (%) 342 (53.9) 60 (55) 0.82 Free fluid, n (%) 139 (21.7) 13 (11.9) 0.02 Hollow viscus injury, n (%) 63 (9.8) 6 (5.5) 0.15 Mortality, n (%) 7 (1.1) 6 (5.5) <0.01 CONCLUSION: Despite a similar rate of HVI, OAs with an A-SBS had an increased rate of mortality and hospital length of stay. To improve quality of care in this population, there should be heightened vigilance when caring for OAs presenting with A-SBS.