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. 2024 Jan 29;12(2):311.
doi: 10.3390/biomedicines12020311.

The Relationship between Injury Characteristics and Post-Traumatic Recovery after Diffuse Axonal Injury

Rita de Cássia Almeida Vieira  1   2 , Leonardo Zumerkorn Pipek  3 , Daniel Vieira de Oliveira  4 , Wellingson Silva Paiva  5 , Regina Marcia Cardoso de Sousa  2
Affiliations

The Relationship between Injury Characteristics and Post-Traumatic Recovery after Diffuse Axonal Injury

Rita de Cássia Almeida Vieira et al. Biomedicines. .

Abstract

Background: The diagnosis and prognosis of diffuse axonal injury (DAI) remain challenging. This research aimed to analyze the impact on activities of daily living (ADL), functional outcomes, quality of life (QoL), and the association between lesion severity and DAI location identified through imaging exams.

Methods: This prospective cohort study included 95 patients diagnosed with DAI. Data were collected at admission, three, six, and twelve months post-injury. The associations between variables were evaluated using a mixed-effects model.

Results: Functional recovery and QoL improved between three and twelve months after DAI. An interaction was observed between independence in performing ADL and subarachnoid hemorrhage (p = 0.043) and intraventricular hemorrhage (p = 0.012). Additionally, an interaction over time was observed between the Glasgow Outcome Scale (GOS) and DAI severity (p < 0.001), brain lesions (p = 0.014), and the Disability Rating Scale (DRS) with injury in brain hemispheres (p = 0.026) and Adams classification (p = 0.013). Interaction effects over time were observed with the general health perceptions and energy/vitality domains with intraventricular hemorrhage, and the social functioning domain with the obliteration of basal cisterns and Gentry's classification.

Conclusion: The use of CT in the acute phase of DAI is important for predicting outcomes. The severity and location of DAI are associated with functional outcomes, ADL, and QoL.

Keywords: CT imaging; diffuse axonal injury; functional outcomes; quality of life; traumatic brain injury.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Patient recruitment flow chart.
Figure 2
Figure 2
Stratification for Glasgow Outcome Scale and Disability Rating Scale at discharge, three months, six months, and twelve months after diffuse axonal injury (n = 74 surviving patients).
Figure 3
Figure 3
Evolution of the average functional recovery assessed by GOS and DRS in DAI patients (n = 74) at three, six, and twelve months after trauma. GOS: Glasgow Outcome Scale; DRS: Disability Rating Scale; DAI: diffuse axonal injury.
Figure 4
Figure 4
Evolution of independence to perform ADLs and IADL assessed by Katz and Lawton in DAI patients (n = 74) at three, six, and twelve months after trauma. ADLs: activities of daily living; IADL: instrumental activities of daily living; DAI: diffuse axonal injury.
Figure 5
Figure 5
Evolution of quality of life assessed by SF-36 in DAI patients at three, six, and twelve months after trauma. SF-36: Short Form-36; DAI: diffuse axonal injury.
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