Fatal Seatbelt Syndrome in an Elderly Wheelchair User: A Case Report

Elderly wheelchair users face unique challenges in traffic collisions due to physiological fragility and the limitations of standard vehicle seatbelt systems. Seatbelt syndrome, a pattern of abdominal organ and spinal injuries, can be severe when seatbelts do not properly align with an individual's body configuration. Moreover, geriatric out-of-hospital cardiac arrest (OHCA) has a low survival rate, even with advanced prehospital care. This case study presents a 90-year-old woman, secured in her wheelchair with a two-point lap belt, who was involved in a low-speed rear-end collision. Initially alert, she rapidly deteriorated into shock and subsequently exhibited pulseless electrical activity (PEA), ultimately leading to her demise despite attempts at resuscitation using resuscitative endovascular balloon occlusion of the aorta (REBOA) and emergency thoracotomy. Postmortem examination revealed hepatic and splenic injuries consistent with seatbelt syndrome. The patient's advanced age, short stature, and wheelchair dependence likely contributed to excessive abdominal force and fatal hemorrhage. While REBOA can provide transient circulatory stabilization, prolonged full occlusion increases the risk of ischemic complications. Emergency thoracotomy also shows limited benefit in geriatric blunt trauma, highlighting the need for more selective criteria. This case underscores the importance of improving seatbelt restraint systems for wheelchair users, refining guidelines for REBOA and emergency thoracotomy in geriatric trauma, and implementing multifaceted prevention strategies to reduce avoidable deaths among elderly wheelchair users.