Abstract
Purpose
There are limited data comparing the severity of traumatic adrenal injury (TAI) and the need for interventions, such as transfusions, hospitalization, or incidence of adrenal insufficiency (AI) and other clinical outcomes. The aim of this study was to analyze the relationship between the grade of TAI and the need for subsequent intervention and clinical outcomes following the injury.
Methods
After obtaining Institutional Review Board approval, our trauma registry was queried for patients with TAI between 2009 and 2017. Contrast-enhanced computed tomography (CT) examinations of the abdomen and pelvis were evaluated by a board-certified radiologist with subspecialty expertise in abdominal and trauma imaging, and adrenal injuries were classified as either low grade (American Association for the Surgery of Trauma (AAST) grade I–III) or high grade (AAST grade IV–V). Patients without initial contrast-enhanced CT imaging and those with indeterminate imaging findings on initial CT were excluded.
Results
A total of 129 patients with 149 TAI were included. Eight-six patients demonstrated low-grade injuries and 43 high grade. Age, gender, and Injury Severity Score (ISS) were not statistically different between the groups. There was an increased number of major vascular injuries in the low-grade vs. high-grade group (23% vs. 5%, p < 0.01). No patient required transfusions or laparotomy for control of adrenal hemorrhage. There was no statistical difference in hospital length of stay (LOS), ventilator days, or mortality. Low-grade adrenal injuries were, however, associated with shorter ICU LOS (10 days vs. 16 days, p = 0.03).
Conclusion
The need for interventions and clinical outcomes between the low-grade and high-grade groups was similar. These results suggest that, regardless of the TAI grade, treatment should be based on a holistic clinical assessment and less focused on specific interventions directed at addressing the adrenal injury.
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Change history
21 July 2022
A Correction to this paper has been published: https://doi.org/10.1007/s10140-022-02078-6
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The authors have no disclosures pertinent to this manuscript. Dr Jonathan Nguyen, DO receives honoraria from Zimmer-Biomet, Teleflex, and Pry-time Medical for educational lectures.
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The original online version of this article was revised: Originally, the article was published with an error in author name. The author “Nickolas Holloway” should be spelled “Nikolas Holloway”.
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Nguyen, J., Ude, N., Holloway, N. et al. Severity of traumatic adrenal injury does not meaningfully affect clinical outcomes. Emerg Radiol 29, 895–901 (2022). https://doi.org/10.1007/s10140-022-02069-7
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DOI: https://doi.org/10.1007/s10140-022-02069-7