Blunt Adrenal Injury: Results of a State Trauma Registry Review

Abstract

In the past, injuries to the adrenal glands due to blunt trauma were considered rare, and were reported to be associated with high Injury Severity Scores (ISSs) and high mortality. Recent reports have reported a much high incidence associated with lower ISS and lower mortality. The purpose of this study was to assess the incidence of adrenal gland injuries due to blunt trauma in a large state trauma registry and determine whether these injuries are associated with a higher ISS and increased risk for mortality. A retrospective review was performed on the New York State Trauma Registry comparing blunt injured adults with adrenal injuries to those who did not. Concurrent organ injuries, ISS, and inhospital mortality were compared. Three hundred thirty-nine patients with adrenal gland injuries were identified. Concurrent liver and kidney injuries were more prevalent in the adrenal injured group, and concurrent injuries to the small and large intestine and spleen were more prevalent in the nonadrenal injured group. There was no difference in ISS or mortality between the adrenal injured and nonadrenal injured populations. The results of this study are consistent with recent smaller studies which identified incidence rates which were higher than previously reported and that ISS and mortality risk were unchanged by the presence of blunt adrenal gland injuries. Adrenal gland injuries due to blunt trauma are not uncommon, with an incidence rate of 0.61 per cent. Adrenal gland injuries are not associated with higher ISS or an increased risk of mortality.

Acute traumatic injuries of the adrenal gland: results of analysis of the Pennsylvania trauma outcomes study registry

“…10–12 The incidence of BAGI in Pennsylvania was 0.43%, compared with 0.61% for New York and 0.52% for our single institution. 7 …”

“…These findings are similar to the mortality rates from the NYSTR of 6.6% and 8.2%, which were also not statistically different. 7 …”

Nonoperative treatment of a blunt adrenal gland trauma with blush: A case report

“…Abdominal trauma due to automotive events is often the main cause of isolated adrenal gland injuries [ 6 ]. At admission, the patient's Shock Index was 1.038 and the Injury Severity Score (ISS) was 2.…”

“…These findings corroborate the results of similar cases reports, which usually have a benign progression and low scores. A review by DiGiacomo et al postulated that adrenal traumas rarely significantly increase the ISS and that a negative relationship between ISS and adrenal trauma can exist when compared to similar cases considering other factors such as age, year of admission, and race [ 5 , 6 ].…”

“…Most adrenal traumas are unilateral and on the right side [ 8 ]. They are usually associated with other abdominal intraperitoneal traumas, such as those of the liver (41.6%), kidney (27.8%), and spleen (22%) [ 7 ], and are rarely found in isolation, occurring in only 1.5% of the traumas [ [6] , [7] , [8] ]. The right adrenal gland is more likely to be affected than the contralateral gland due to its anatomical position close to the spinal bone structures and drainage through the vena cava.…”