CT imaging in assessing the severity of retroperitoneal injuries in blunt abdominal trauma

Background: Trauma is a leading cause of death in developing countries due to vehicular and railway accidents, of which abdominal trauma due to blunt injuries constitutes 13% mortality and 45% morbidity. The purpose of this study is to assess and diagnose the severity of those retroperitoneal injuries other than the common causes of abdominal trauma with multidetector computed tomography (MDCT) scanning with intravenous contrast being the gold standard diagnostic modality even in unstable patients.Methods: A total of 204 patients of these 147 patients were males (72%) and 57 were females (28%) were included of all age groups, who had sustained abdominal trauma due to vehicular, railways accidents and also due to trivial trauma and history of fall from heights.Results: Of the 204 patients included in our study, 110 patients (55%) had the maximum trauma affection to the kidneys, in which 48% constitutes grade I injury, which shows the high sensitivity of MDCT detecting early injuries. Nearly 12% patients had adrenal injuries, 24% had pancreatic injuries, although a small percentage also had delayed manifestation of pseudocyst formation in stable patients. Duodenal and colonic injuries constitute rest of 5% and 4% of the patients. All these patients had good correlation with the morphological MDCT grading of injuries and clinical correlation.Conclusions: MDCT is the imaging procedure of choice for early detection or ruling out the presence of retroperitoneal injuries in trauma patients, especially now with the newer faster MDCT, scanning can be performed more quickly, minimizing patient movement, respiratory motion and vascular pulsation.

Are Adrenal Injuries Predictive of Adrenal Insufficiency in Patients Sustaining Blunt Trauma?

Adrenal insufficiency (AI) is an uncommon life-threatening development in trauma patients. The aim of this study was to determine if adrenal injury sustained during blunt trauma is associated with an increased risk of AI. A single-institution retrospective cohort review was performed over a 3-year period on all patients with blunt trauma requiring intensive care admission and mechanical ventilation for longer than 24 hours. Adrenal injuries were identified on admission CT scan. All patients with AI were identified as noted by practice management guidelines. Patients were stratified by Injury Severity Score (ISS) as less than 16, 16 to 25, and greater than 25 and relative risks were calculated. Multiple logistic regression was performed using age, race, sex, Glasgow Coma Scale, ISS, length of hospitalization, and adrenal injury as covariates with AI as the outcome of interest. A secondary analysis was then performed with adrenal injury classified as bilateral versus unilateral or no adrenal injury and relative risks were calculated for ISS strata. A total of 2072 patients were identified with 71 developing AI. Adrenal injuries were noted in 113 patients with eight subsequently developing AI. Multiple logistic regression model (P < 0.01) showed that age (P < 0.01) and increasing ISS (P = 0.02) were predictive of AI. Adrenal injury was not an independent predictor of AI (P = 0.12). After controlling for age and ISS, adrenal injury was not an independent predictor of the development of AI. Adrenal insufficiency should be considered with increasing injury severity and age in the intensive care setting after blunt trauma.