Value of Emergent Neurovascular Imaging for “Seat Belt Injury”: A Multi-institutional Study

Article Figures & Data

Download figure
Open in new tab
Download powerpoint
FIG 1.
Flow chart of patients showing the incidence rate of BCVI among 2 subgroups of patients after an MVC based on the presence of additional traumatic findings other than the cervical seat belt sign.
Download figure
Open in new tab
Download powerpoint
FIG 2.
CTA of a 71-year-old male patient shows absent vascular opacification (arrow) in an occlusive dissection of the left vertebral artery (A). There is a mildly displaced fracture of the left transverse process/foramen of C5 (arrow) evident on the corresponding bone window (B). The coronal reconstructed image demonstrates occlusion of the V1 and proximal V2 segments and the absence of flow below the C6 vertebral level (grade IV) (arrow) (C), with a reconstituted left vertebral artery above from collaterals.

Table 1:

Clinical and imaging characteristics of patients with cervical seat belt sign

Characteristics
No. (% female)
Adult	535 (67.6)
Pediatric	32 (56.2)
Total	567 (67.0)
Age (mean) [SD] (range) (yr)
Adult	42.2 [SD, 18.4], (18–91)
Pediatric	13.0 [SD, 4.0], (6–17)
Mean GCS [SD] (No.)	14.9 [SD, 0.8], (519)
On-scene LOC (No.) (%)
No	400 (70.5)
Yes	65 (11.5)
Unclear or amnesic to the event	51 (9.0)
Clinical data not available	51 (9.0)
Neurologic deficit (No.) (%)
New FND	6 (1.1)
New FND inconsistent with head
CT/MR imaging	3 (0.5)
Clinical data not available	41 (7.2)
Associated traumatic findings (No.)
Fractures
Skull	2
Midface (maxilla, mandible)	5
Cervical vertebrae (only C1–3)	20 (6)
First rib or clavicle	20
Upper ribs (2–4)	35
Lower ribs (5–12)	10
Sternum	30
Upper thoracic vertebra	10
Cervical ligamentous injury	3
Scalp/neck hematoma	7/7
Thoracic vascular injuries Intracranial hemorrhage	113
No additional finding per patient (%)	450 (79.4)
At least 1 additional finding^{^a} (%)	117 (20.6)
No. of patients with BCV (%)	12 (2.1)

↵a Including a new FND, a GCS score of <8, or any of the above-listed associated traumatic findings to the head, neck, or chest.

Table 2:

Comparison of adult patients without BCVI versus patients with BCVI (18 years of age or older)

	Without BCVI (n = 523)	With BCVI (n = 12)	P Value
Female/male	355:168	7:5	.53
Age (mean) [SD] (yr)	42.1 [SD, 18.4]	43.6 [SD, 20.7]	.86^{^a}
GCS (mean) [SD]	14.9 [SD, 0.8](GCS: 3 = 1 patientGCS: 7 = 1 patientOthers: >8)	14.8 [SD, 0.6](GCS: 13 = 1 patientOthers =15)	.55^{^a}
On-scene LOC (No/yes/unclear)	370/56/48	8/4/0	.06
Neurologic deficit
New FND	4 (0.7%)	2 (16.7%)	.007
New FND inconsistent with head CT/MR imaging	2 (0.4%)	1 (8.3%)	.07
At least 1 additional traumatic head/neck/chest injury
All	103 (19.7%)	9 (75%)	<.001
All except scalp/neck hematoma	82 (15.7%)	7 (58.3%)	.001
Head injury
Intracranial hemorrhage	11 (2.1%)	2 (16.7%)	.031
Skull fracture/hematoma	2 (0.4)/7 (1.3%)	0
Midface fracture	5 (0.9%)	0

Cervical injury
Cervical spine fracture	15 (2.9%)	4 (33.3%)	<.001
C1–3 fracture	5 (1.0%)	1 (8.3%)	.12
Spinal ligamentous injury	2 (0.4%)	0
Neck hematoma	7 (1.3%)
Thoracic injury
First rib/clavicle fracture	19 (3.6%)	1 (8.3%)	.37
Upper rib fracture	43 (8.2%)	2 (16.7%)	.26
Any rib fracture	53 (10.1%)	3 (25%)	.12
Sternal fracture	27 (5.2%)	3 (25%)	.02
Vertebral fracture	8 (1.5%)	0
Vascular injury	1 (0.2%)