Background: The seat belt does not alter the amount of force sustained in an accident, but it does alter the distribution of that force, in attempting to place it across the less vulnerable pelvic area. Its greatest usefulness is in the rollover type accidents and in preventing ejection from the vehicle. The aim of the present study was to review the literature about the sea-belt. Methods: An extensive literature search was performed aiming to identify and review research studies that investigate the causes and the consequences of the seat belt syndrome during the last 25 years. The databases that were searched were: the Cochrane Library, Medline and PubMed. Results: There are a number of significant risk factors associated with seat-belt nonuse in the general public: male gender, young age, passenger status, risk-taking rural living, low level of education, black or hispanic ethnicity, having few dependents or children, smoking, speeding, alcohol consumption before driving and travelling on secondary roads late in the day. The seat belt syndrome is most commonly associated with using a lap belt, but has also been reported in occupants using three-point restraints. In these cases the patient often has cutaneous signs of injury with a lap belt mark. The seatbelt syndrome itself is characterized by injuries in the plane of the lap portion of the belt particularly with laceration of the colon, small bowel and occasionally the stomach, laceration of the liver and spleen, occasional injury of the pancreas, major vascular injuries. Some spinal injuries, such as lumbar spine or spinal cord injury are included in the 'seat-belt syndrome', but it is not clear whether or not these injuries are caused directly by the belt. Conclusions: Seat belts are effective in reducing the incidence of major and fatal injuries in automobile accidents.
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