Introduction: Diffuse axonal injury (DAI) is believed to be caused by acceleration-deceleration forces affecting long white matter tracts that result in reduced level of consciousness following acute traumatic brain injury (TBI). There are scarce studies describing the overall outcomes of DAI and how some clinical factors influence it. The purpose of this study is to determine long term outcome in patients with MRI-proven DAI according to the Extended Glasgow Outcome Score (GOSE.)
Methods: Retrospective review of 71 patients with MRI-proven DAI at a level one trauma center from 11/2004-04/2014. MRIs were graded using ADAMS score based on location and extent of the white matter lesions. Glasgow Outcome Score extended (GOS-E) was calculated following telephone interview >6 months following initial injury. Data are expressed as M±SD if parametric and median (interquartile range) if nonparametric.
Results: The population was 66.7% male, age 33±16 years, Injury Severity Score of 30±11, admission GCS 7±4, with ICU LOS of 20± 18 days and mortality 5.6%. Independent functional status was regained at home in 74.0% (GOSE >5) and 49.3% returned to full independent functional status (GOSE >7). GOSE was <4 in 25.4%, 4-6 in 25.4%, and 7-8 in 49.3%. For GOSE <4 vs GOSE 4-8, baseline characteristics, GCS, and outcomes were similar, but hospital LOS was longer [48(23-96) vs 25(11-44) days, p<0.002]. Patients with Adam’s Grade III DAI had significantly worse functional recovery vs Grade I or II (both p<0.01.), but patients with DAI Grade I or II had similar functional recovery (93.3% vs 71.0%, respectively.)
Conclusions: DAI may result in devastating neurological injury but this study
demonstrates that a meaningful recovery is possible and that the prognosis may not be as poor as previously believed. Furthermore, this study suggests that either differences in management, comorbidities or different imaging characteristics may influence long term outcomes.
Patient Care: This study will improve patient care by identifying certain TBI
patient with DAI that will regain independent functional status.
Learning Objectives: By conclusion of this session, participants should be able to: 1)
Identify DAI as one of the major causes of neurovegetative state and disability in patients that experience TBI. 2) Identify DAI on diagnostic imaging like MRI of the Brain 3) Current treatment modalities available for patients with DAI. 4) Identify certain clinical factors that may influence long term outcomes in patients with a diagnosis of DAI after TBI. 5) Certain percentage of patients will regain independent functional status at home even though DAI is believed to be catastrophic.