Thyroid Trauma-A National Analysis of Incidence, Mortality, and Concomitant Injury

Background: Traumatic injury to the thyroid is rare with no large national studies in the literature. We sought to describe the incidence of traumatic thyroid injury and to compare injury characteristics, operative interventions, and outcomes of isolated thyroid versus thyroid and concomitant neck injury. Methods: The National Trauma Data Bank (2007-2015) was used to identify patients with thyroid injury. Concomitant injury to surrounding neck structures included the trachea, esophagus, carotid arteries, cervical spine vertebrae, or vertebral arteries. A multivariable logistic regression analysis was performed. Results: The incidence of thyroid injury was <0.1%. Of these, 59.7% of patients had isolated thyroid injury and 40.3% had thyroid and concomitant neck injury. Most patients in both groups had a penetrating mechanism (75.8% and 85.6%). Thyroid operative intervention was rare in both groups (isolated thyroid injury 19.3%, thyroid and concomitant neck injury 22.1%). Direct thyroid repair was the most common type of surgical intervention performed (isolated thyroid 13.1% versus thyroid and concomitant neck injury 15.1%; P = 0.280), whereas total thyroidectomy was only performed in a single patient. Mortality was decreased for patients with isolated thyroid injury compared with thyroid and concomitant neck injury (8.9% versus 19%; P < 0.001). Conclusions: Thyroid injury in trauma patients is extremely rare and occurs more frequently with penetrating trauma. Isolated thyroid trauma is associated with a lower risk of mortality, compared to thyroid trauma with concomitant neck injury. Most thyroid injury is treated nonoperatively, and when operative intervention is required, direct thyroid repair is most commonly performed. (C) 2019 Elsevier Inc. All rights reserved.