Department of Surgery, University of North Dakota School of Medicine and Health Sciences, 1919 N Elm Street, 1301 N Columbia Rd Stop 9037 Grand Forks 58202-9037, Fargo, ND 58102, United States.
Department of Surgery, University of North Dakota School of Medicine and Health Sciences, 1919 N Elm Street, 1301 N Columbia Rd Stop 9037 Grand Forks 58202-9037, Fargo, ND 58102, United States.
Injury. 2024 Sep;55(9):111613. doi: 10.1016/j.injury.2024.111613. Epub 2024 May 15.
Traumatic blunt adrenal injury (BAI) has been an area of debate, with conflicting data on its impact. BAI from blunt abdominal injury is challenging to diagnose early due to retroperitoneal gland location and minimal clinical signs. The incidence of BAI ranges from 0.03 % to 4.95 %, with an increasing trend attributed to advanced CT imaging. Conflicting data exists regarding BAI's implications on patient outcomes, necessitating a comprehensive evaluation.
A retrospective review of the National Trauma Data Bank (NTDB®) for 2017-2021 included a total of 352,654 patients with 337,628 polytrauma patients and 15,026 isolated abdominal trauma patients. Patients were categorized into those with and without adrenal injury. Demographic data and outcomes were compared using statistical tests, focusing on Injury Severity Scores (ISS), mortality, length of stay, and ventilation days.
Polytrauma patients with BAI had increased mortality, longer ICU and hospital stays, and ventilation requirements when compared to polytrauma patients without BAI. However, when evaluating isolated abdominal trauma patients with BAI showed no significant differences when compared to isolated abdominal trauma without BAI in mortality or ICU LOS and a slight decrease in ICU admissions, hospital LOS, and ventilation requirement.
The study indicates a significant association between BAI and increased trauma severity among polytrauma patients. Mortality, however, did not exhibit a consistent rise across all patients with adrenal injury, emphasizing that BAI may not independently influence outcomes. These findings align with the notion that adrenal injury is linked to the overall trauma burden rather than being a primary determinant of mortality.
外伤性钝性肾上腺损伤（BAI）一直存在争议，其对患者的影响存在相互矛盾的数据。由于肾上腺位于腹膜后，且临床症状不明显，因此由腹部钝性伤导致的 BAI 很难早期诊断。BAI 的发生率为 0.03%至 4.95%，这一趋势归因于先进的 CT 成像技术的应用。BAI 对患者结局的影响存在相互矛盾的数据，因此需要进行全面评估。
对 2017 年至 2021 年国家创伤数据库（NTDB®）进行回顾性分析，共纳入 352654 例患者，其中 337628 例为多发伤患者，15026 例为单纯腹部创伤患者。患者分为有肾上腺损伤和无肾上腺损伤两组。使用统计检验比较两组的人口统计学数据和结局，重点比较损伤严重程度评分（ISS）、死亡率、住院时间和通气天数。
与无 BAI 的多发伤患者相比，有 BAI 的多发伤患者死亡率更高，ICU 和住院时间更长，通气需求更大。然而，在评估有 BAI 的单纯腹部创伤患者时，与无 BAI 的单纯腹部创伤患者相比，死亡率、ICU 住院时间和 ICU 入住率无显著差异，而 ICU 入院率、住院时间和通气需求略有下降。
该研究表明 BAI 与多发伤患者创伤严重程度增加之间存在显著关联。然而，死亡率并未在所有有肾上腺损伤的患者中持续上升，这强调了 BAI 可能不会独立影响结局。这些发现与肾上腺损伤与整体创伤负担相关，而不是死亡率的主要决定因素的观点一致。
