Impact of blunt adrenal gland injury (BAGI) in major trauma: a systematic review and meta-analysis

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BACKGROUND: Blunt adrenal gland injuries (BAGI) are rare and typically reflect high-energy trauma. Despite suggestions that BAGI may be a marker of increased injury severity and mortality, evidence remains conflicting. We conducted a systematic review and meta-analysis to assess the impact of BAGI on trauma severity, in-hospital mortality, and hospital length of stay (LOS). METHODS: A systematic search of PubMed, Scopus, and Embase was performed up to August 31, 2024. Studies comparing adult blunt trauma patients with and without BAGI were included. Data on Injury Severity Score (ISS), in-hospital mortality, and LOS were extracted. The risk of bias was assessed using ROBINS-E; certainty of evidence was evaluated via GRADE. Random and fixed effects models were applied based on heterogeneity levels. RESULTS: Eight retrospective studies involving 379,070 patients, including 15,990 with BAGI, met inclusion criteria. BAGI patients had significantly higher ISS (mean difference [MD]: 7.18; 95 % CI 2.59-11.76; p = 0.012). In-hospital mortality was not initially different (OR 1.10; 95 % CI 0.69-1.73), but sensitivity analysis excluding heterogeneity-influencing studies showed increased mortality in BAGI patients (OR 1.51; 95 % CI 1.2-1.91; p = 0.007). No significant difference in LOS was observed (MD: 3.26 days; 95 % CI - 1.56-8.10; p = 0.13). Evidence certainty was moderate for ISS and mortality, and low for LOS. CONCLUSIONS: BAGI is associated with higher trauma severity and, potentially, increased mortality. While not independently predictive, its presence should prompt awareness of severe polytrauma. Standardized injury grading and prospective data are needed to clarify BAGI's prognostic role.

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