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Traditional trauma teaching is to admit trauma patients with abdominal wall ecchymosis caused by seat belts (seat belt sign) for fear of missing a hollow viscus injury leading to peritonitis and sepsis.
Over the past few years there have been studies pointing toward the safety of discharging blunt abdominal trauma patients with a negative CT even if they do have a seat belt sign.
In this most recent study, a negative CT was defined as
1. No free fluid (free fluid was the leading indicator of occult hollow viscus injury)
2. No solid organ injury
3. No bowel wall irregular contours, thickening, hematoma or air
4. No abdominal wall soft tissue contusion
5. No mesenteric stranding or hematoma
6. No bowel dilatation
If the patient’s CT did not include any of these findings, there was a 0.01% chance of finding a delayed hollow viscus injury. The authors conclude it is safe to discharge patients meeting these criteria.
If we include no rebound or guarding on physical exam along with a negative CT scan, it appears to be safe to discharge trauma patient’s with seat belt sign.