Diffuse Axonal Injury: Epidemiology, Outcome and Associated Risk Factors.
Diffuse axonal injury (DAI), a type of traumatic injury, is known for its severe consequences. However, there are few studies describing the outcomes of DAI and the risk factors associated with it. This study aimed to describe the outcome for patients with a primary diagnosis of DAI 6 months after trauma and to identify sociodemographic and clinical factors associated with mortality and dependence at this time point. Seventy-eight patients with DAI were recruited from July 2013 to February 2014 in a prospective cohort study. Patient outcome was analyzed using the Extended Glasgow Outcome Scale (GOS-E) within 6 months of the traumatic injury. The mean Injury Severity Score was 35.0 (SD = 11.9), and the mean New Injury Severity Score (NISS) was 46.2 (SD = 15.9). Mild DAI was observed in 44.9% of the patients and severe DAI in 35.9%. Six months after trauma, 30.8% of the patients had died, and 45.1% had shown full recovery according to the GOS-E. In the logistic regression model, the severity variables - DAI with hypoxia, as measured by peripheral oxygen saturation, and hypotension with NISS value - had a statistically significant association with patient mortality; on the other hand, severity of DAI and length of hospital stay were the only significant predictors for dependence. Therefore, severity of DAI emerged as a risk factor for both mortality and dependence.
School of Nursing, University of São Paulo (USP-SP) , São Paulo , Brazil.
Rita de Cássia Almeida
RC
Vieira
Department of Neurology, School of Medicine, University of São Paulo (USP-SP) , São Paulo , Brazil.
Wellingson Silva
WS
Paiva
Department of Neurology, School of Medicine, University of São Paulo (USP-SP) , São Paulo , Brazil.
Daniel Vieira
DV
de Oliveira
Department of Neurology, School of Medicine, University of São Paulo (USP-SP) , São Paulo , Brazil.
Manoel Jacobsen
MJ
Teixeira
Department of Neurology, School of Medicine, University of São Paulo (USP-SP) , São Paulo , Brazil.
Almir Ferreira
AF
de Andrade
School of Nursing, University of São Paulo (USP-SP) , São Paulo , Brazil.
Regina Márcia Cardoso
RM
de Sousa
Glasgow Outcome Scale; cohort study; diffuse axonal injury; head trauma; recovery; severe traumatic brain injury