Thesis title: Blunt ADrenal Gland injUrY in major trauma. BAD GUY project.
Introduction:
The Blunt ADrenal Gland injUrY (BAD GUY) Project is a multi-phase research initiative investigating the clinical significance, epidemiology, and pathophysiology of adrenal gland injury following major blunt trauma. Despite increasing detection due to widespread CT use, blunt adrenal gland injury (BAGI) remains underrecognized and poorly characterized, with inconsistent evidence regarding its impact on trauma outcomes.
Methods:
The project comprised two completed research phases and one ongoing translational component.
1. Systematic Review and Meta-analysis: A comprehensive literature review and meta-analysis (PROSPERO ID: CRD42024510565) were conducted following PRISMA and AMSTAR guidelines. Studies comparing trauma severity, in-hospital mortality, and length of stay between BAGI and non-BAGI patients were included.
2. Multicenter Retrospective Cohort Study: A nine-center European study (NCT06220448) analyzed data from 1,997 patients with blunt thoracoabdominal trauma (241 with BAGI). Propensity score matching (1:3 ratio) was applied to control for confounders, and outcomes were evaluated by adrenal injury laterality and Organ Injury Scale (OIS) grade.
3. Ongoing Translational Phase (MaCoRTEs Study): This developing study aims to assess cortisol dynamics and adrenal responsiveness in trauma and emergency surgical patients, addressing the metabolic dimension of stress response.
Results:
The meta-analysis demonstrated that BAGI patients exhibited significantly higher Injury Severity Scores (MD 7.45; 95% CI 2.57–12.33; p = 0.01), indicating an association with more severe trauma. However, no significant independent increase in mortality or hospital stay was found. The multicenter study confirmed BAGI prevalence at 12.1% among thoracoabdominal trauma patients. BAGI correlated with hemodynamic instability and higher procedural resource use but was not an independent predictor of mortality after propensity adjustment. OIS grading and bilateral involvement emerged as key prognostic factors warranting standardized reporting.
Discussion and Conclusion:
Collectively, the BAD GUY Project redefines BAGI from a radiological curiosity to a clinically relevant marker of injury severity. The results support its interpretation as a surrogate indicator of trauma magnitude rather than a direct cause of adverse outcomes. The forthcoming MaCoRTEs study will extend these findings into endocrine and metabolic research, linking trauma physiology to hormonal response. This thesis thus integrates epidemiological, clinical, and translational evidence to advance a more comprehensive understanding of adrenal involvement in trauma care.