Diffuse axonal injury (DAI) in moderate to severe head injured patients: Pure DAI vs. non-pure DAI

Moinay Kim; Jae Sung Ahn; Wonhyoung Park; Suk Kyung Hong; Sang Ryong Jeon; Sung Woo Roh; Seungjoo Lee

doi:10.1016/j.clineuro.2018.06.011

Diffuse axonal injury (DAI) in moderate to severe head injured patients: Pure DAI vs. non-pure DAI

Clin Neurol Neurosurg. 2018 Aug:171:116-123. doi: 10.1016/j.clineuro.2018.06.011. Epub 2018 Jun 10.

Authors

Moinay Kim¹, Jae Sung Ahn¹, Wonhyoung Park¹, Suk Kyung Hong², Sang Ryong Jeon¹, Sung Woo Roh¹, Seungjoo Lee³

Affiliations

¹ Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea.
² Division of Trauma and Surgical Critical Care, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea.
³ Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea; Division of Neurosurgical Critical Care, Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 05505, Republic of Korea. Electronic address: rghree@amc.seoul.kr.

PMID: 29909182
DOI: 10.1016/j.clineuro.2018.06.011

Abstract

Objective: Diffuse axonal injury (DAI) is known to be associated with poor outcome. DAI often associates with other intracranial injuries but their distinct features have not been established. In this retrospective cohort study, we compared clinical outcomes between pure and non-pure DAI patients.

Patients and methods: Total of 1047 traumatic brain injury (TBI) patients visited our institute between 2011 and 2017. Age ranged between 15-85 years old and Glasgow coma scale (GCS) score less than 13 were included. DAI was diagnosed in 45 patients using CT and MRI and their clinical features and outcomes were compared depending on their associated cranial injury; 20 patients without evidence of associated injury (Pure DAI group) and other 25 patients with associated injury (Non-pure DAI group). DAI stage was adopted using Gentry, L.R.

Classification: Glasgow outcome scale (GOS) was measured at least 6 months after trauma to evaluate their functional outcome.

Results: The mean age and follow-up period were 45.36 years and 15.09 months, respectively. There were no significant differences between pure and non-pure DAI groups regarding demographic data and clinical findings on their admission. Logistic regression model was used to examine the association between GOS and clinical factors. In this analysis, pure DAI was no significantly different to non-pure DAI (p = 0.607). However, DAI Stage, transfusion, and hypotension on admission were strongly related to poor outcome. Stage III showed sevenfold higher risk when compared to Stage I (p = 0.010). The risk was also high when Stage III was compare to Stage I and II (p = 0.002). Interestingly, no significant difference was observed between Stage I and II (p = 0.847).

Conclusions: Unfavorable outcome was observed in 14 patients (31.11%) which was lower than we expected. Interestingly, non-pure DAI was no worse than pure DAI on their functional outcome. However, DAI Stage III was independently associated with poor outcome when compared to Stage I or I and II. Finally, we concluded that Stage II is clinically more related to Stage I, rather than Stage III.

Keywords: Brain injury; Diffuse axonal injury; Head injury; Head trauma; Traumatic brain injury.

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Brain Injuries, Traumatic / complications
Brain Injuries, Traumatic / surgery*
Craniocerebral Trauma / complications
Craniocerebral Trauma / surgery*
Diffuse Axonal Injury / surgery*
Female
Glasgow Outcome Scale
Head / surgery*
Humans
Male
Middle Aged
Prognosis
Retrospective Studies
Young Adult