Medical Student Case Western Reserve University School of Medicine Cleveland, Ohio, United States
Disclosure(s):
Mohamed E. El-Abtah, BA: No financial relationships to disclose
Introduction: Diffuse axonal injury (DAI) is a devastating traumatic neurological injury with variable prognosis. Although outcomes such as mortality functional outcomes have been described, the time course of neurological progression is poorly understood. We investigated the association between DAI neuroanatomical injury pattern and timing of neurological recovery.
Methods: A retrospective review of our institution’s trauma registry identified patients diagnosed with DAI from 2017-2021. CT scans were analyzed by neuroradiologists to score DAI severity (Grade 1=lobar white matter; Grade 2=corpus callosum; Grade 3=brainstem involvement). In-hospital neurological exams were reviewed, and GCS scores (including eye, motor, and verbal subscores) were calculated for all patients throughout the hospital stay. Categorical variables were analyzed using Fisher’s exact test and continuous variables were analyzed using ANOVA.
Results: Nineteen DAI patients (Grade 1=8; Grade 2=1; Grade 3=10) were included (mean age 31 years, 79% male). Mean Rotterdam CT score (Grade 1=3, Grade 2=4, Grade 3=2), Injury Severity Scale (Grade 1=33, Grade 2=29, Grade 3=34), and admission GCS (Grade 1=5, Grade 2=7, Grade 3=5) were comparable across DAI grades. There was no difference in mortality (p=0.58) or withdrawal of care (p=0.58) across DAI grades. Time to follow commands was shorter for those with Grade 1 DAI (9.3 days [95% CI: 3.5-14.1] compared to a Grade 2 (17 days) or Grade 3 (19 days [95% CI: 8.7-25.4]) DAI (p=0.02). Throughout hospitalization, patients with Grade 1 DAI had higher motor (p=0.006), eye (p=0.001), and total GCS (p=0.011) score compared to those with Grade 2 or 3 DAI. At the time of discharge, total GCS score (p=0.71) and the frequency of command following was similar across DAI grades (p=0.31).
Conclusion : Patients with Grade 1 DAI demonstrated the fastest short-term neurological recovery, although final discharge neurological examination was comparable across DAI grades. DAI classification can provide useful short-term prognostic information regarding in-hospital neurological improvement.
