title: Adrenal gland injury secondary to blunt traumatic mechanisms: a marker of overall injury severity.
abstract: BACKGROUND
  Adrenal gland injuries (AGI) are seen increasingly frequently owing to advances in modern imaging techniques. This study describes a series of patients with blunt AGI, with the emphasis on AGI as a marker of injury severity, CT-radiographic classification of AGI and associated injury patterns.
  
  
  METHODS
  A retrospective review of blunt trauma patients with AGI was performed. Variables examined included demographics, mechanism of injury, length of hospital and ICU stay, clinical status on admission, AGI characteristics, associated injuries, complications, procedures, mortality and discharge disposition.
  
  
  RESULTS
  There were 29 AGI patients with a mean injury severity score of 25. The most common injury mechanisms were motor-vehicular collisions (15/29) and falls (5/29). Right-sided AGI (16/29) outnumbered left-sided (12/29) injuries. The most common CT-radiographic types of AGI were adrenal gland contusions and lacerations with limited "blush". While patterns of injuries differed between right and left-sided AGI, the mean number of injuries did not. The most common associated injuries included extremity (21/29), rib (20/29) and spinal fractures (18/29). Common procedures included orthopaedic fixation (10/29), vena cava filter (8/29) and tracheostomy (5/29). A median of two complications per patient was reported, including adrenal insufficiency in two patients. Mortality was 17%. The median hospital and ICU length of stay were 15 and 12 days, respectively.
  
  
  CONCLUSIONS
  Adrenal gland injury is associated with significant morbidity and mortality. With modern imaging modalities capable of reliably detecting adrenal injury, the presence of AGI should be considered a marker of overall injury severity. The authors provide a CT-radiographic classification of adrenal injuries.
authors.affiliation: Department of Surgery, St Luke's Hospital and Health Network, Bethlehem, PA, USA. stawicki.ace@gmail.com
authors.forename: S Peter
authors.initials: SP
authors.lastname: Stawicki
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Seamon
authors.forename: Carla M
authors.initials: CM
authors.lastname: Carvalho
authors.forename: Nilesh
authors.initials: N
authors.lastname: Bhoot
authors.forename: Rohit
authors.initials: R
authors.lastname: Sharma
authors.forename: Sherwin P
authors.initials: SP
authors.lastname: Schrag
authors.forename: Steven M
authors.initials: SM
authors.lastname: Steinberg
mesh_terms: D000311:Adrenal Glands / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D000328:Adult; D005260:Female; D050723:Fractures, Bone / Q000145:classification / Q000000981:diagnostic imaging; D006801:Humans; D007902:Length of Stay; D008297:Male; D009104:Multiple Trauma / Q000145:classification* / Q000000981:diagnostic imaging* / Q000601:surgery; D011859:Radiography; D012189:Retrospective Studies; D014949:Wounds, Nonpenetrating / Q000145:classification* / Q000000981:diagnostic imaging* / Q000601:surgery