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BACKGROUND:Adrenal trauma is extremely rare and current literature is lacking in data from large case series. In this study, we analyze adrenal injuries using the National Trauma Data Bank (NTDB).
METHODS:We performed a retrospective analysis of the NTDB from the years 2007-2011. Patient demographics, Injury Severity Score (ISS), mechanism of injury, and blunt versus penetrating trauma, associated injuries and hypovolemic shock were assessed. Multivariable models were used to determine associations with outcomes such as need for surgery, type of surgery mean length of stay, need for ICU, and death.
RESULTS:Of the 1,766,606 trauma cases in the data set, 8683 were identified involving one or both adrenal glands. There were 7835 blunt and 663 penetrating injuries, and 184 of these injures were isolated to the adrenal glands Of the 8683 adrenal injuries, 80 (0.9%) required surgery. However, none of the 184 isolated adrenal injures required surgery (p=0.42).Factors associated with isolated adrenal injury include lower ISS (p<0.001), younger age (p<0.001), and penetrating injury (p<0.001). No isolated adrenal injuries were associated with death (12% vs. 0%, p<0.0001).The most common associated organ injuries were ribs (50.9%), thoracic (50.0%), liver (41.6%), vertebrae (30.9%), kidney (27.8%), and spleen (22.0%). Logistic regression showed that injures to the thorax (p=0.0014) and multiple abdominal injuries (p<0.001) were associated with a lower rate of undergoing adrenal surgery. Higher ISS score (p=0.007), penetrating injury (p<0.001), race (Black) (p=0.029) and concurrent injuries to the spleen (p<0.001) and intestines (p=0.016) were associated with a higher likelihood of requiring adrenal surgery. Older age (p<0.001), higher ISS score (p<0.001), race (Black, Other) (p=0.03, p=0.02), penetrating injuries (p<0.001) and injuries to the aorta/vena cava (p=0.008), vessels (p=0.001), thorax (p=0.03), ribs (p=0.005), stomach (p=0.02), liver (p=0.03), multiple abdominal injuries (p=0.002), and brain/spinal cord (p<0.001) were associated with a higher mortality rate.
CONCLUSIONS:Adrenal injuries are rare, comprising 0.49% of all traumatic injuries. In our database, isolated adrenal injuries were not fatal and did not require surgery. Younger age, race (Black), higher ISS score, penetrating injury, and concurrent injuries to the spleen/intestines were associated with a higher likelihood of requiring an adrenalectomy.