Are traumatic bilateral adrenal injuries associated with higher morbidity and mortality?-A prospective observational study.

BACKGROUND: Traumatic bilateral adrenal injuries are uncommon. Adrenal injuries are overall associated with worse outcome than non-adrenal injuries. However, direct comparative evidence between unilateral and bilateral adrenal injuries is unavailable in literature. This study aims to investigate clinical significance of bilateral adrenal hematomas in terms of injury severity, morbidity and mortality.

METHODS: All blunt trauma abdomen patients with adrenal gland involvement on initial CECT scans of abdomen presenting to our Level 1 trauma centre over 21 months were prospectively included and followed-up. Patients were divided into unilateral and bilateral adrenal hematoma groups. For all patients, mechanism of injury, initial pulse, blood pressure, respiratory rate, Glasgow Coma Scale (GCS) scores, Injury Severity Score (ISS), New Injury Severity Score (NISS), length of ICU stay (LOI), length of hospital stay (LOS), total blood products (TBP) received were recorded. Final outcome was noted as complete recovery; discharge with poor prognosis and death. Quantitative parameters between both groups were compared using appropriate statistical tests and P < 0.05 was considered significant.

RESULTS: Forty seven patients were detected to have adrenal hematomas, 34 with unilateral (30 right and 4 left) and 13 with bilateral involvement. An oval mass replacing the gland was the most common appearance of injury (35/60) and periadrenal fat stranding was most common associated finding (47/60). Patients with bilateral adrenal hematoma had significantly lower GCS (13 vs 15, P < 0.01), ISS (38 vs 22, P < 0.01), NISS (47 vs 21, P < 0.01), LOI as proportion of LOS (91.7 % vs 10.5 %, P = 0.01) and TBP received (10 vs 4 units, P < 0.05). Outcome in bilateral group was comparatively worse with higher proportion of deaths or discharge with poor prognosis (P = 0.000).

CONCLUSIONS: Patients with bilateral adrenal injury are associated with higher injury severity, morbidity and mortality compared to unilateral adrenal injury.