title: Epidemiology of Traumatic Adrenal Injuries Requiring Surgery.
abstract: 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.
authors.affiliation: Division of Urology, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA. Electronic address: vraup@partners.org.
authors.forename: Valary T
authors.initials: VT
authors.lastname: Raup
authors.affiliation: Division of Urology, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Jairam R
authors.initials: JR
authors.lastname: Eswara
authors.affiliation: Division of Urology, Department of Surgery, Barnes Jewish Hospital, Washington University School of Medicine, St Louis, MO.
authors.forename: Joel M
authors.initials: JM
authors.lastname: Vetter
authors.affiliation: Department of Urology, New York Presbyterian Hospital/Columbia University Medical Center, Columbia University College of Physician and Surgeons, New York, NY.
authors.forename: Steven B
authors.initials: SB
authors.lastname: Brandes
mesh_terms: D000007:Abdominal Injuries / Q000453:epidemiology / Q000601:surgery; D000311:Adrenal Glands / Q000293:injuries* / Q000601:surgery*; D000465:Algorithms; D005260:Female; D006801:Humans; D008297:Male; D018579:Patient Selection; D012189:Retrospective Studies