title: Early prognosis after severe traumatic brain injury with minor or absent computed tomography scan lesions.
abstract: BACKGROUND
  To assess the prognostic value of corpus callosum lesions (CCL) and brain stem lesions (BSL) in diffuse axonal injury (DAI) patients.
  
  
  METHODS
  From December 1989 to December 2008, 102 consecutive patients with pure DAI were admitted to our neurosurgical intensive care unit. Age, gender, Acute Physiology and Chronic Health Evaluation score, Glasgow Coma Score (GCS), pupillary light reactivity on admission, brain magnetic resonance imaging (MRI) 24 hours to 72 hours after trauma and sepsis, shock, adult respiratory distress syndrome, renal failure, neurosurgery, high intracranial pressure during the 6 months posttrauma were studied with multiple logistic regression, and Cox's proportional hazards, respectively, considering the Glasgow Outcome Scale and the time to recovery of consciousness as outcome variables.
  
  
  RESULTS
  Four variables predicted unfavorable Glasgow Outcome Scale (likelihood ratio p<0.0001; Area Under the Receiver Operator Curve (AUROC)=0.92; Naglekerke's R=0.64; Goodness-of-Fit p=0.8679): age (5-year odds ratio [OR], 1.44; 95% CI, 1.14-1.82; p=0.002), bilateral absence of light reflexes (OR, 11.11; 95% CI, 2.19-57.67; p=0.004), multiplicity of CCL (OR, 29.23; 95% CI, 7.06-121.01; p<0.001), and multiplicity of BSL (OR, 9.43; 95% CI, 2.44-36.42; p=0.001). Four variables affected time to recovery of consciousness: age (hazard ratio, 0.98; 95% CI, 0.97-0.99; p=0.009), bilateral absence of light reflexes (hazard ratio, 0.51; 95% CI, 0.27-0.97; p=0.041), multiplicity of CCL (hazard ratio, 0.40; 95% CI, 0.25-0.66; p<0.001), and total GCS on admission (hazard ratio, 1.45; 95% CI, 1.23-1.71; p<0.001).
  
  
  CONCLUSIONS
  In DAI patients, bad outcome is predicted by age, bilateral absence of pupillary light reflexes, multiplicity of CCL, and BSL on MRI. Time to recovery of consciousness is predicted by age, bilateral absence of light reflexes, multiplicity of CCL on MRI, and GCS on admission.
authors.affiliation: Department of Head and Neck Anesthesia and Intensive Care, San Raffaele Scientific Institute, Via Olgettina, 60, 20132 Milan, Italy.
authors.forename: Maria Rosa
authors.initials: MR
authors.lastname: Calvi
authors.forename: Calvi Maria
authors.initials: CM
authors.lastname: Rosa
authors.forename: Luigi
authors.initials: L
authors.lastname: Beretta
authors.forename: Beretta
authors.initials: B
authors.lastname: Luigi
authors.forename: Antonio
authors.initials: A
authors.lastname: Dell'Acqua
authors.forename: Dell'Acqua
authors.initials: D
authors.lastname: Antonio
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Anzalone
authors.forename: Anzalone
authors.initials: A
authors.lastname: Nicoletta
authors.forename: Gloria
authors.initials: G
authors.lastname: Licini
authors.forename: Licini
authors.initials: L
authors.lastname: Gloria
authors.forename: Marco
authors.initials: M
authors.lastname: Gemma
authors.forename: Gemma
authors.initials: G
authors.lastname: Marco
mesh_terms: D000328:Adult; D000367:Age Factors; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D001930:Brain Injuries / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D001933:Brain Stem / Q000000981:diagnostic imaging / Q000293:injuries / Q000473:pathology; D016001:Confidence Intervals; D003337:Corpus Callosum / Q000000981:diagnostic imaging / Q000293:injuries / Q000473:pathology; D005260:Female; D015600:Glasgow Coma Scale; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D016017:Odds Ratio; D011379:Prognosis; D016016:Proportional Hazards Models; D012372:ROC Curve; D014057:Tomography, X-Ray Computed