Clinical Significance of the Seat Belt Sign as Evidence of a
Compromised Occupant–Seat Belt Relationship


Dr. Mathew Greenston, Dr. Rawson L. Wood, and Dr. Lars Reinhart


The Journal of Emergency Medicine, Vol. 56, No. 6, pp. 624–632, 2019
Copyright 2019 The Authors. Published by Elsevier Inc.


Seat belt marks are seen frequently on occupants after motor vehicle accidents. Over the years, the clinical significance of these marks has changed as restraint systems have evolved. With modern restraint systems, signs of a compromised occupant–restraint relationship are an important and easily identified bedside finding. Objectives: We sought to learn to recognize seat belt marks that demonstrate an abnormal occupant–restraint system relationship and to cultivate an understanding of significant soft tissue biomechanical loading associated with marks caused by a compromised occupant–restraint relationship. Discussion: A review of case studies from the literature combined with forensic work demonstrate a strong correlation between significant injury and improper seatbelt use. When evidence of a compromised occupant–restraint relationship exists, incorporating computed tomography angiography and observation may be clinically indicated. Conclusion: The recognition of seat belt marks made by a compromised occupant–restraint relationship is an important finding that allows risk stratification of the patient at the bedside. Further investigation with a prospective trial at a trauma center is warranted.

Copyright 2019 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (