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. 2025 Apr 3:8:42299.
doi: 10.2340/jrm-cc.v8.42299. eCollection 2025.

LONG-TERM OUTCOMES OF MODERATE TO SEVERE DIFFUSE AXONAL TRAUMATIC BRAIN INJURY: A PROSPECTIVE STUDY

Marianne Lannsjö  1 , Jörgen Borg  2 , Anders Lewén  3 , Charlotta VON Seth  4 , Per Enblad  3 , Sami Abu Hamdeh  3
Affiliations

LONG-TERM OUTCOMES OF MODERATE TO SEVERE DIFFUSE AXONAL TRAUMATIC BRAIN INJURY: A PROSPECTIVE STUDY

Marianne Lannsjö et al. J Rehabil Med Clin Commun. .

Abstract

Introduction: Traumatic brain injury (TBI) with diffuse axonal injury (DAI) necessitates significant medical and rehabilitation interventions. The late long-term outcome is variable with potential for neurodegenerative development and deterioration. This study evaluates the late long-term outcomes of moderate to severe TBI with DAI.

Methods: Patients aged 16-65 with moderate to severe TBI and DAI were included. From 2006 to 2018, 30 patients (mean age 34; 21 males, 9 females) were enrolled. Outcomes were assessed using the Glasgow Outcome Scale Extended (GOSE) at 6 months and ≥ 1-year post-injury.

Results: At 6 months, 10 patients had a favourable outcome (GOSE 6-8), increasing to 12 at ≥ 1-year post-injury. Patients with unfavourable outcomes were older (mean 40) than those with favourable outcomes (mean 24, p < 0.001). DAI stage correlated with outcomes (p = 0.003). GOSE remained unchanged in 15 patients, improved in 9 and deteriorated in 6 between the 6 months and the ≥ 1-year follow-up.

Discussion: Approximately one-third of TBI patients with DAI achieved favourable long-term outcomes, and the outcome changed in half of the patients between 6 months and ≥ 1 year follow-up. Age and DAI stage were significant predictors of outcome. Further studies are required to enhance prognostic accuracy and explore rehabilitation's impact.

Keywords: GOSE; diffuse axonal injury; long-term outcome; traumatic brain injury.

Plain language summary

Traumatic brain injury (TBI) with widespread damage to the brain’s nerve fibres, a condition called diffuse axonal injury (DAI), necessitates intense medical and rehabilitative interventions. The long-term outcome is variable, and some patients may deteriorate over time. This study investigated the long-term outcomes of patients with moderate and severe TBI with DAI. Thirty patients, aged 16–65 years, who had suffered moderate to severe TBI with DAI were followed, and the recovery was evaluated at 6 months and > 1 years post-injury. After 6 months, 10 patients had a good recovery, which increased to 12 patients after > 1 year. Patients with poor outcomes were older (average age 40) than those with good outcomes (average age 24), and the severity of DAI was associated with recovery. We conclude that one-third of DAI patients achieved a favourable outcome. Age and DAI severity were factors associated with recovery.

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Conflict of interest statement

The authors have no conflict of interest to declare.

Figures

Fig. 1
Fig. 1
Glasgow outcome scale extended at 6 months and at second follow-up ≥ 1 year for each patient, related to time at follow-up in months. GOSE: Glasgow coma scale extended; DAI: Diffuse axonal injury; a = follow-up at 6 months post-injury, b = second follow-up, red = deterioration, green = improvement, grey = unchanged.
See this image and copyright information in PMC

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