The seatbelt sign as a silent warning in blunt abdominal trauma

Author: Basil Iqbal Sait, Vasavi Shenoy Bellare / Editor: Nick Tilbury / Codes: RP4, SLO2, SLO4, SLO6 / Published: 14/08/2025

A 24-year-old female is brought to the Emergency Department (ED) following a high-speed, front and rear-end road traffic collision. She was the restrained driver, and airbags were deployed. She managed to self-extricate. Her past medical history is unremarkable and she doesn’t take any regular medications.

Your examination findings are as follows:

Airway: Patent

Breathing: SpO2 99% on air. Respiratory rate 16. Normal-looking chest wall. Equal bilateral air entry, no chest wall tenderness.

Circulation: Heart rate 85/min, blood pressure 132/78. No external bleeding, capillary refill <2 sec.

Disability: GCS 15, pupils equal and reactive. Normal neurological examination

Exposure: Subtle Seatbelt mark noted across the left lower abdomen, with mild tenderness on palpation. Soft abdomen.

There is no C-spine or long bone tenderness, and no other external signs of trauma.

A bedside eFAST scan shows a small amount of free fluid in the spleno-renal space.

Blood tests are unremarkable, including normal haemoglobin and lactate.