Epidemiology of Traumatic Adrenal Injuries Requiring Surgery

doi:10.1016/j.urology.2016.03.022

Urology

Volume 94, August 2016, Pages 227-231

https://doi.org/10.1016/j.urology.2016.03.022 Get rights and content

Objective

To analyze adrenal injuries using the National Trauma Data Bank. Adrenal trauma is rare and current literature is lacking in data from large case series.

Methods

A retrospective analysis of the National Trauma Data Bank from the years 2007-2011 was performed. Patient demographics, Injury Severity Score (ISS), mechanism of injury, type of trauma, associated injuries, and development of shock were assessed. Multivariable models were used to determine association with outcomes, such as characterization of injury, need for adrenalectomy, intensive care unit admission, and death.

Results

Of the 1,766,606 trauma cases recorded, 7791 involved 1 or both adrenal glands (0.44%). Common associated injuries were to the ribs (50.9%), thorax (50.0%), and liver (41.6%). Eighty adrenal injuries required surgery (80/7791, 1.0%), none of which were isolated adrenal injuries (0/120, P = .63). Higher ISS (P = .009), Black race (P = .031), penetrating injury (P < .001), and splenic (P < .001) and intestinal injuries (P = .018) were associated with need for adrenalectomy. No isolated adrenal injuries were associated with death (12% vs 0%, P < .0001). Older age (P < .001), higher ISS (P < .001), chronic kidney disease (P = .009), penetrating injuries (P < .001), and injuries to the aorta/vena cava (P = .008), peripheral vasculature (P < .0001), thorax (P = .029), brain/spinal cord (P < .001), and abdominal polytrauma (P = .005) were associated with mortality.

Conclusions

Adrenal injuries are rare, comprising 0.44% of recorded traumatic injuries. Isolated adrenal injuries were not fatal and did not require surgery, and thus should be managed conservatively. Detection of adrenal injury in polytrauma patients is key, particularly penetrating trauma and concurrent splenic and/or intestinal injuries, as these patients are more likely to require adrenalectomy.

Section snippets

Methods

We performed a retrospective analysis of the NTDB from 2007 to 2011. The following International Classification of Diseases-9 diagnosis codes where used to identify adrenal injury: 868.01, 868.11, 868.09, and 868.19. The dataset was limited to patients ≥16 years of age. The following codes were used to determine if the patient received an adrenal procedure: 7.22, 7.29. 7.3, 7.43, 7.44, and 7.49. The algorithm used to select patients can be seen in Figure 1. Patient demographics, Injury Severity

Results

Of the 1,766,606 trauma cases in the dataset, 7791 were identified involving 1 or both adrenal glands (0.44%). There were 7026 blunt, 646 penetrating, and 119 unclassified injuries. The most common associated organ injuries were to the ribs (50.9%), thorax (50.0%), liver (41.6%), vertebrae (30.9%), kidney (27.8%), and spleen (22.0%). Of the adrenal injuries, 120 were isolated to the adrenal glands (120/7791, 1.5%). Factors associated with isolated adrenal injury include lower ISS (P < .001),

Discussion

Trauma is the fifth leading cause of death in the United States and the leading cause of death worldwide.⁶ Nearly 1.8 million injuries were captured in the NTDB from 2007 to 2011, of which only 0.44% affected either 1 or both adrenal glands. This rate is slightly higher than the previously published rates of 0.15%-0.22%; these discrepancies could be attributed to the fact that prior studies were performed using single-institution data, or that the utilization of computed tomography scans

Conclusion

Adrenal injuries are rare, comprising 0.44% of recorded traumatic injuries. To our knowledge, this is the first study using a national database to examine the characteristics of these traumas. In our database, isolated adrenal injuries were not fatal and did not require surgery, thus surgeons should feel comfortable managing these injuries conservatively. We should be vigilant about detecting adrenal injuries in polytrauma patients, particularly those of a penetrating etiology or who present

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Cited by (12)

Blunt Adrenal Injury is Not Associated With Worse Outcomes in Adult Trauma Patients
2024, Journal of Surgical Research
Blunt adrenal injury is rare. Given production of hormones including catecholamines, adrenal injury may lead to worse outcomes. However, there is a paucity of literature on this topic. As such, we compared blunt trauma patients (BTPs) with and without adrenal injuries, hypothesizing similar mortality and complications between cohorts.
The 2017-2019 Trauma Quality Improvement Program database was queried for adult (≥18-year-old) BTPs. Patients with penetrating trauma, traumatic brain injury, severe thoracic injury, or who were transferred from another hospital were excluded. Patients with adrenal injury were compared to those without using a 1:2 propensity score model. Matched variables included patient age, comorbidities, vitals on admission and concomitant injuries (i.e., liver, spleen, kidney, pancreas, and hollow viscus). Univariable logistic regression was then performed for associated risk of mortality.
2287 (0.2%) BTPs had an adrenal injury, with 1470 patients with adrenal injury matched to 2940 without adrenal injury. The rate of all complications including sepsis (0.1% versus 0.0%) was similar between cohorts (all P > 0.05). Patients with adrenal injury had a lower rate of mortality (0.1% versus 0.6%, P = 0.035) but increased length of stay (4 [3-6] versus 3 [2-5] days, P = 0.002). However, there was no difference in associated risk of mortality for patients with and without adrenal injury (odds ratio = 0.234; confidence interval = 0.54-1.015; P = 0.052).
Blunt adrenal injury occurred in <1% of patients. After propensity matching, there was a similar associated rate of complications but longer hospital length of stay for patients with adrenal injury. Adrenal injury was not associated with an increased risk of mortality.
Nonoperative treatment of a blunt adrenal gland trauma with blush: A case report
2021, Trauma Case Reports
Citation Excerpt :
It usually results from blunt and high-impact thoracoabdominal trauma, such as motor vehicle collisions, with a mortality rate of 7% to 32.6% [1]. Contrast computed tomography (CT) of the abdomen and pelvis is the gold standard for such diagnosis [3,4]. A trauma to the adrenal gland is rare due to the retroperitoneal position of the gland and its relationship with adjacent soft tissues [1,2].
Adrenal gland trauma is a rare and scarcely reported injury due to its retroperitoneal position and relationship with adjacent tissues. We report a male patient with a history of a thoracoabdominal blunt trauma with adrenal injury as an isolated abdominal viscera. He was hemodynamically stable at admission, with a blush within his adrenal hematoma. The patient was treated nonoperatively and subsequently discharged after 15 days. The available literature reports advantages of a nonoperative approach compared to surgery, which is necessary in only 1% of cases that are predominantly polytrauma patients with multiple intra-abdominal injuries. Therefore, a nonoperative treatment is recommended for patients with an isolated adrenal gland injury who are hemodynamically stable during hospital stay.
Adrenal gland injury due to gunshot
2020, Chinese Journal of Traumatology - English Edition
Citation Excerpt :
As such, adrenal trauma tends to be incidentally discovered and usually associated with injuries to other organs, most commonly the ribs, liver, kidneys, and spleen.2,3,5 Penetrating injury accounts for only 1.4%–18.6% of all adrenal trauma and has been associated with higher rates of exploratory laparotomy, adrenalectomy, and overall mortality as compared to blunt trauma.2–6 Of note, we were unable to find reports of bilateral adrenal injury after penetrating trauma.
Adrenal gland trauma is a rare phenomenon, due to the small size and retroperitoneal location of the organ. The majority of adrenal gland trauma is due to blunt force injury and is only rarely encountered due to the penetrating mechanisms. A 20-year-old male sustained a gunshot wound to the left abdomen. Upon exploration, he was found to have a through and through injury to the left adrenal gland, among other injuries. Injury to the adrenal gland due to penetrating trauma is exceptionally rare. The principles of management are to control bleeding from the gland with debridement and hemostasis rather than attempt to resect the entire organ. The management of a penetrating injury to the adrenal gland is straightforward and should not be a contributor to a patient's morbidity or mortality.
Management of blunt adrenal gland injury in a community-based hospital
2019, Injury
Citation Excerpt :
Some minor cases may have been missed because only 47% of our patients had CT scan. Nevertheless, the findings of our study, which stemmed from a community-based hospital, is similar to those from large trauma centers and National Trauma Data Bank with 1,766,606 recorded trauma cases [26]. This is important for the generalizability of the findings of this rare condition.
Injury of the adrenal gland in blunt trauma is rare. The routine usage of the whole body computed tomography (CT) scan helps in early diagnosis. We aimed to study the incidence, mechanism of injury, management, and outcome of adrenal injury in blunt trauma patients treated in a community-based hospital.
CT scan of the abdomen of all blunt trauma patients who were admitted to our institution between October 2010 and March 2018 were retrospectively reviewed. The files of all the patients with CT scan-detected adrenal injuries were retrieved. Studied variables included demography, mechanism of injury, associated injuries, GCS, ISS, Intensive Care Unit admission, hospital stay, and outcome.
4991 blunt trauma patients were admitted to the hospital. CT scan of the abdomen was performed for 2359 (47%) patients. Blunt adrenal injuries were diagnosed in eleven male patients (0.22%). The main mechanism of injury was motor vehicle collisions in eight (72.7%) patients. Nine (81.8%) patients had right adrenal gland injury. The mean (range) ISS was 22 (6–50). All patients had intra-adrenal hematoma and periadrenal fat stranding. None of our patients had acute adrenal insufficiency. One patient died (overall mortality 9.1%).
The incidence of blunt adrenal injury, although rare, is similar in a community-based hospital to those reported from trauma I centers. It is associated with severe and multiple organ injuries. Blunt adrenal injuries are usually self-limiting.
Approach and Management of Traumatic Retroperitoneal Injuries
2018, Cirugia Espanola
Las lesiones traumáticas retroperitoneales constituyen un desafío para el cirujano de traumatología. Ocurren generalmente en el contexto de un paciente politraumatizado, con múltiples lesiones asociadas y en el que los procedimientos invasivos tienen un rol preponderante en el diagnóstico de estas lesiones. El retroperitoneo es la región anatómica que presenta mayores tasas de mortalidad, por lo que el diagnóstico precoz y tratamiento de estas lesiones adquiere especial relevancia. El objetivo de este trabajo es presentar la evidencia científica publicada hasta el momento en cuanto a su prevalencia, mecanismo lesional, métodos diagnósticos y tratamiento mediante una revisión de la literatura internacional de los últimos 70 años. Como conclusión, en esta revisión sistemática se pone de manifiesto una creciente tendencia al manejo no quirúrgico de las lesiones que afectan el retroperitoneo.
Traumatic retroperitoneal injuries constitute a challenge for trauma surgeons. They usually occur in the context of a trauma patient with multiple associated injuries, in whom invasive procedures have an important role in the diagnosis of these injuries. The retroperitoneum is the anatomical region with the highest mortality rates, therefore early diagnosis and treatment of these lesions acquire special relevance. The aim of this study is to present current published scientific evidence regarding incidence, mechanism of injury, diagnostic methods and treatment through a review of the international literature from the last 70 years. In conclusion, this systematic review showed an increasing trend towards non-surgical management of retroperitoneal injuries.
Rare benign adrenal lesions
2023, European Journal of Endocrinology

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: Financial Disclosure: The authors declare that they have no relevant financial interests.

¹: These authors contributed equally to this work.

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Reconstructive UrologyEpidemiology of Traumatic Adrenal Injuries Requiring Surgery

Objective

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Conclusion

Curr Surg

Urology

J Urol

J Emerg Med

J Am Coll Surg

Adrenal gland injury secondary to blunt traumatic mechanisms: a marker of overall injury severity

Endokrynol Pol

Adrenal gland trauma: diagnosis and management

J Trauma

Critical care for the patient with multiple trauma

J Intensive Care Med

Reconstructive Urology
Epidemiology of Traumatic Adrenal Injuries Requiring Surgery