Treatment Outcome and Risk Factors Associated with Diffuse Axonal Injury in Patients with Moderate to Severe Head Injury

Abstract

AIM: To evaluate diffuse axonal injury (DAI) patients according to DAI stage to identify risk factors that may affect clinical outcome. MATERIAL and METHODS: A total of 992 traumatic brain injury (TBI) patients visited our hospital between 2011 and 2016. Thirty-seven patients diagnosed with DAI were enrolled in this study and stratified by DAI stage: Stage I, 20 patients (54.1%); Stage II, 4 patients (10.8%); and Stage III, 13 patients (35.1%). RESULTS: The mean age and the median follow-up period were 45.43 years and 13 months, respectively. Patient demographic data and clinical findings on admission showed no differences according to DAI stage, except for the revised trauma score (RTS) (p=0.026). In univariate analysis, stages I and II vs. III (p=0.001) and stages I vs. II and III (p=0.019), transfusion within 24 hours of visit (p=0.033), shock or cardiac arrest (p=0.006), traumatic subarachnoid hemorrhage (T-SAH) (p=0.011), and subdural hematoma (SDH) (p=0.009) were significantly correlated with Glasgow outcome score (GOS). In multivariate analysis, DAI stage I and II vs. III (p=0.005) and SDH (p=0.040) were significant. CONCLUSION: Clinically, Stage II was more correlated with Stage I, rather than stage III. Stage III showed a much poorer outcome compared to stages I and II. Magnetic resonance imaging (MRI) should be promptly performed in all TBI patients when a patient’s level of consciousness and cranialcomputed tomography (CT) does not match, as there is a possibility of stage III DAI.