title: Adrenal gland trauma: is extravasation an absolute indication for intervention?
abstract: BACKGROUND
  Adrenal gland trauma (AGT) is potentially devastating if unrecognized during the treatment of trauma patients. Because of the adrenal glands' rich vascularity, they often hemorrhage upon traumatic impact. However, there has been no conclusion about the indications for intervention in cases of hemorrhage after AGT.
  
  
  METHODS
  We conducted a prospective collection with a retrospective review in a Level I trauma center in Taiwan. This study enrolled all of the patients who suffered from AGT from May 2008 to May 2013. We retrieved and analyzed the patient demographic data, clinical presentation, AGT grade, injury severity score, management, hospital stay, and mortality.
  
  
  RESULTS
  The cohort consisted of 60 patients. The mean age was 31.0 ± 15.9 years. There were 32 patients (53.3 %) with extravasated AGT, which was associated with a high injury severity score, a high possibility of associated lung injury, and more than one accompanying trauma. Most of the patients could be treated conservatively. Five of these patients needed surgical hemostasis, and four of them needed angiographic embolization. Extravasation combined with a mean arterial pressure <70 mmHg was a predictor of the need for intervention (relative risk: 9.52, 95 % CI 1.64-55.56, p = 0.011).
  
  
  CONCLUSIONS
  In conclusion, AGT is a rare injury with a good prognosis. Most AGT patients can be treated conservatively. Extravasation in AGT is not only a sign of hemorrhage, but also an indicator of severe associated injuries. However, extravasation in AGT does not always require further treatment. When intractable hypotension simultaneously occurs, further treatment should be considered.
authors.affiliation: Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5 Fu-Hsing Street, Kwei-Shan Shiang, Taoyuan, Taiwan, surgymet@gmail.com.
authors.forename: Chien-Hung
authors.initials: CH
authors.lastname: Liao
authors.forename: Kuo-Jen
authors.initials: KJ
authors.lastname: Lin
authors.forename: Chih-Yuan
authors.initials: CY
authors.lastname: Fu
authors.forename: Shang-Yu
authors.initials: SY
authors.lastname: Wang
authors.forename: Shang-Ju
authors.initials: SJ
authors.lastname: Yang
authors.forename: Chun-Hsiang
authors.initials: CH
authors.lastname: Ouyang
mesh_terms: D000293:Adolescent; D000311:Adrenal Glands / Q000098:blood supply / Q000293:injuries* / Q000601:surgery*; D000328:Adult; D062186:Arterial Pressure; D002648:Child; D003287:Contrast Media; D004621:Embolization, Therapeutic; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000175:diagnosis*; D005260:Female; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D006488:Hemostasis, Surgical; D006801:Humans; D007022:Hypotension / Q000209:etiology / Q000601:surgery*; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013624:Taiwan; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000601:surgery; D055815:Young Adult
chemical_list: D003287:Contrast Media