Adrenal Injuries and Incidentalomas in Trauma Patients at an Urban Trauma Centre
Bibliographic record
Abstract
Background: Trauma patients are frequently evaluated by abdominal computed tomography. The prevalence of adrenal incidentalomas is 4% of the general population, increasing with age. The aim of this study was to examine the incidence and follow-up of adrenal lesions in an adult trauma centre. Methods: A retrospective review was performed of all trauma admissions to an urban trauma centre in Melbourne, Australia between August 2000 and October 2009 with a discharge diagnosis including adrenal injury, mass, or adenoma. Results: From August 2000 through October 2009, there were 45,576 patients admitted to the Alfred Hospital Trauma Unit, 142 (0.31%) patients had adrenal injuries and 26 (0.06%) patients had adrenal incidentalomas. Of the patients with adrenal injuries, the male-to-female ratio was 3:1. Blunt trauma was responsible in 99% of patients. Right-sided injuries were commoner (73%). Left-sided lesions were present in 19%, and bilateral injuries in 5% (P < 0.0001). Adrenal injury was identified as haemorrhage or haematoma in 95%. In the adrenal injury group, there was the 13% mortality. Follow-up imaging was not performed in 50% of patients; while another 30% only had imaging within 2 weeks, while still hospitalised. Of the 26 patients with incidentalomas, the male-to-female ratio was 1.6:1. All were blunt trauma patients, 69% of identified masses were left-sided lesions, 23% right-sided, and 7.7% were bilateral. Repeat imaging was obtained in 58% of patients, while the remainder was lost to follow-up. Biochemical investigations were performed in 54%. One patient had phaeochromocytoma, and 13 patients had benign incidentalomas. Three patients underwent adrenalectomy: one at the time of trauma laparotomy (benign cortical adenoma); one 5 months post-trauma (phaeochromocytoma); and the final patient 3 months post-trauma (benign vascular epithelial cyst). Conclusions: With increased use of abdominal CT in the evaluation of trauma patients, adrenal lesions are increasingly likely to be found. Follow-up of these lesions in this series has been variable. The development of a protocol for adrenal lesions in trauma patients may improve follow-up care. doi: http://dx.doi.org/10.4021/ jcs108w
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".