Conclusion

In this postmortem cohort, TAWH was found at a much higher incidence (20.6%) than is reported in clinical literature, identifying it as a significant marker of fatal, high-energy trauma. TAWH is not specific to motor vehicle occupants but is strongly associated with injury patterns characteristic of seatbelt loading, including thoracic cage, lumbar spine, and pelvic injuries. While our data strongly indicates a correlation between seatbelt use and TAWH, the small number of confirmed non-wearers prevents a definitive conclusion. These findings underscore the need for a high index of suspicion for TAWH in severely injured trauma patients, particularly those with a “seatbelt sign” or associated fractures. Further biomechanical research is warranted to precisely define the injury thresholds and mechanisms leading to traumatic abdominal wall failure.