Traumatic adrenal haematoma: A condition rarely recognised in the emergency department

Objective: To delineate the clinical features of traumatic adrenal haematoma, to help emergency physicians recognise the condition early and so to prevent adrenal crisis. Methods: Review of the records of all patients admitted to Chi-Mei Medical Center, Tainan, Taiwan, with traumatic torso injuries, between 1 August 2003 and 31 August 2005. Of the 305 patients reviewed, 8 had adrenal haematoma. Injury Severity Scores, hospital course, need for intensive care unit admission and surgery or vascular embolisation, and concomitant injuries, were compared between patients with and without adrenal haematoma. Results: No adrenal haematoma was recognised in the emergency department. No case of adrenal haematoma needed surgery or vascular embolisation, but each had associated injuries to other internal organs. All eight patients with, but only 106 patients without, adrenal haematoma sustained injuries to more than one internal organ (p < 0.01). The mean Injury Severity Scores and lengths of hospital and intensive care unit stays among the two groups were not significantly different. There was no statistical significance in the differences in rates of admission to the intensive care unit, mortality, laparotomy or vascular embolisation between the two groups. Conclusions: Emergency physicians were liable in trauma cases to miss adrenal haematoma, which of itself was a benign condition but was associated with increased internal organ injuries and days in the intensive care unit. Emergency physicians should be aware of the possibility of adrenal haematoma in trauma cases in order not to miss the bilateral condition, which might lead to a deadly adrenal crisis.