title: Diffuse axonal injury in patients with head injuries: an epidemiologic and prognosis study of 124 cases.
abstract: BACKGROUND
  Diffuse axonal injury (DAI) is usually associated to severe trauma. Recent imaging advances made its diagnosis easier. Its prognosis impact is not yet well established. The aim of this article is to describe the epidemiologic, clinical, and radiologic features of posttraumatic DAI and to study its prognosis impact on mortality and outcome according to Glasgow Outcome Scale.
  
  
  METHODS
  This is a retrospective study over a 4-year period (2004-2007) of 124 patients admitted for head trauma. Demographic, clinical, biological, and radiologic findings were recorded at admission and during intensive care unit stay.
  
  
  RESULTS
  Mean age (±standard deviation) was 28 years±15.8 years. Cranial computed tomography scan was sufficient enough to diagnose DAI in 31 patients. Magnetic resonance imaging was performed in 105 patients with a delay of 7.7 days±8.6 days. Most patients were classified as stage II (49.5%) or stage III (44.8%) according to Gentry's classification. In a multivariate analysis, factors associated with higher mortality were dysautonomia (p=0.018; odds ratio [OR]=4.17), hyperglycemia≥8 mmol/L (p=0.001; OR=3.84) on intensive care unit admission, and subdural hematoma (p=0.031; OR=3.99), whereas factors associated to poor outcome according to Glasgow Outcome Scale score were Glasgow Coma Scale score<8 (p=0.032, OR=3.55), secondary systemic injuries score≥3 (p=0.034, OR=2.83), hyperglycemia≥8 mmol/L (p=0.002, OR=5.55), and DAI count≥6 (p=0.035, OR=3.33). In patients with pure DAI, the absence of consciousness recovery was the unique independent factor of mortality (p<0.001, OR=116.4), whereas only transfusion need was an independent factor of poor outcome (p=0.017, OR=4.44).
  
  
  CONCLUSIONS
  Dysautonomia, hyperglycemia, and subdural hematoma are the main factors associated to higher mortality when DAIs are diagnosed, whereas a DAI count≥6 is associated to poor outcome. Magnetic resonance imaging classification did not have a prognosis value even in patients with pure DAI.
authors: Service de réanimation médicale, CHU Habib Bourguiba, Sfax, Tunisia.
authors: Hedi
authors: H
authors: Chelly
authors: Anis
authors: A
authors: Chaari
authors: Emna
authors: E
authors: Daoud
authors: Hssan
authors: H
authors: Dammak
authors: Fatma
authors: F
authors: Medhioub
authors: Jameleddine
authors: J
authors: Mnif
authors: Chokri Ben
authors: CB
authors: Hamida
authors: Mabrouk
authors: M
authors: Bahloul
authors: Mounir
authors: M
authors: Bouaziz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000175:diagnosis / Q000453:epidemiology*; D020833:Diffuse Axonal Injury / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D015600:Glasgow Coma Scale; D006408:Hematoma, Subdural / Q000453:epidemiology; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D054969:Primary Dysautonomias / Q000453:epidemiology; D011379:Prognosis; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D055815:Young Adult