Adrenal Hematoma Volume as a Predictor of Morbidity and Mortality in Traumatic Adrenal Injury

TL;DR

This study shows that the size of adrenal hematomas in trauma patients can predict their risk of complications and death, helping guide better care.

Contribution

The study is the first to show that adrenal hematoma volume is an independent predictor of adverse outcomes in traumatic adrenal injury.

Findings

Hematoma volume and lower GCS score were independent predictors of adverse outcomes.

A hematoma volume threshold of >23 cm³ was associated with higher morbidity and mortality.

The study included 60 patients with a morbidity rate of 18.3% and mortality rate of 8.3%.

Abstract

Background: Traumatic adrenal injury (TAI) is a rare but significant condition that affects 2.5% of patients with thoracoabdominal trauma. The impact of adrenal hematoma volume on clinical outcomes remains underexplored. This study aimed to evaluate factors associated with morbidity and mortality in patients with TAI, with a particular focus on adrenal hematoma volume as a predictive marker. Methods: Retrospective data from patients with radiologically confirmed TAI between 2013 and 2023 was analyzed. Clinical, demographic, and radiological variables were reviewed. Hematoma volume was calculated from computed tomography (CT) imaging and analyzed using univariate and multivariate models. Receiver operating characteristic (ROC) analysis was employed to evaluate its predictive accuracy. Results: Sixty patients were included in the study. The median hematoma volume was 16.0 cm3, with a predominance of injuries on the right side. The morbidity and mortality rates were 18.3% and 8.3%, respectively. Univariate analysis identified a lower Glasgow Coma Scale (GCS) score, higher Injury Severity Score (ISS), and increased hematoma volume as significant factors. In multivariate analysis, hematoma volume and GCS score remained independent predictors of adverse outcomes. A volume threshold of >23 cm3 was associated with significantly higher morbidity and mortality (AUC = 0.80, 95% CI: 0.68–0.92). Conclusions: This study is the first to demonstrate that the volume of adrenal hematoma is an independent predictor of adverse outcomes in patients with traumatic adrenal injury. Integrating volume into clinical assessment may help identify high-risk patients requiring improved observation and management.

Figures