Related Experiment Video
Updated: Feb 14, 2026
Induction of Diffuse Axonal Brain Injury in Rats Based on Rotational Acceleration
Published on: May 9, 2020
Prognosis of diffuse axonal injury with traumatic brain injury
Stephen S Humble1, Laura D Wilson, Li Wang
1From the Section of Surgical Sciences, Division of Trauma and Surgical Critical Care, Departments of Surgery and Neurosurgery (S.S.H., M.A.S., J.C.S., M.F.M., M.B.P.), Vanderbilt Brain Institute, Vanderbilt Center for Health Services Research, Vanderbilt University Medical Center, Nashville, Tennessee; College of Medicine (S.S.H.), University of Tennessee Health Science Center (UTHSC), Memphis, Tennessee; Department of Communication Sciences and Disorders (L.D.W.), Oxley College of Health Sciences, The University of Tulsa, Tulsa, Oklahoma; Department of Hearing and Speech Sciences (L.D.W., M.B.P.), Department of Biostatistics (L.W.), Vanderbilt University School of Medicine (D.A.L., J.C.S., A.B., S.P., M.A.D., M.B.P.), Nashville, Tennessee; Department of Emergency Medicine (D.A.L.), San Antonio Military Medical Center, Fort Sam Houston, Texas; Vanderbilt University (M.A.S.); Meharry Medical College, Nashville, Tennessee; (M.A.S.); Department of Radiology and Radiological Sciences (A.B., S.P., M.A.D.), Vanderbilt University Medical Center, Nashville, Tennessee; Department of Neurology (S.M.), University of Massachusetts Medical School, University of Massachusetts Medical Center, Worcester, Massachusetts; and Surgical Service, General Surgery Section, Geriatric Research, Education and Clinical Center Service, Department of Veterans Affairs Medical Center (M.B.P.), Tennessee Valley Health Care System, Nashville, Tennessee.
Background:
Determine the prognostic impact of magnetic resonance imaging (MRI)-defined diffuse axonal injury (DAI) after traumatic brain injury (TBI) on functional outcomes, quality of life, and 3-year mortality.
Methods:
This retrospective single center cohort included adult trauma patients (age > 17 years) admitted from 2006 to 2012 with TBI. Inclusion criteria were positive head computed tomography with brain MRI within 2 weeks of admission. Exclusion criteria included penetrating TBI or prior neurologic condition. Separate ordinal logistic models assessed DAI's prognostic value for the following scores: (1) hospital-discharge Functional Independence Measure, (2) long-term Glasgow Outcome Scale-Extended, and (3) long-term Quality of Life after Brain Injury-Overall Scale. Cox proportional hazards modeling assessed DAI's prognostic value for 3-year survival. Covariates included age, sex, race, insurance status, Injury Severity Score, admission Glasgow Coma Scale Score, Marshall Head computed tomography Class, clinical DAI on MRI (Y/N), research-level anatomic DAI Grades I-III (I, cortical; II, corpus callosum; III, brainstem), ventilator days, time to follow commands, and time to long-term follow-up (for logistic models).
Results:
Eligibility criteria was met by 311 patients, who had a median age of 40 years (interquartile range [IQR], 23-57 years), Injury Severity Score of 29 (IQR, 22-38), intensive care unit stay of 6 days (IQR, 2-11 days), and follow-up of 5 years (IQR, 3-6 years). Clinical DAI was present on 47% of MRIs. Among 300 readable MRIs, 56% of MRIs had anatomic DAI (25% Grade I, 18% Grade II, 13% Grade III). On regression, only clinical (not anatomic) DAI was predictive of a lower Functional Independence Measure score (odds ratio, 2.5; 95% confidence interval, 1.28-4.76], p = 0.007). Neither clinical nor anatomic DAI were related to survival, Glasgow Outcome Scale-Extended, or Quality of Life after Brain Injury-Overall Scale scores.
Conclusion:
In this longitudinal cohort, clinical evidence of DAI on MRI may only be useful for predicting short-term in-hospital functional outcome. Given no association of DAI and long-term TBI outcomes, providers should be cautious in attributing DAI to future neurologic function, quality of life, and/or survival.
Level Of Evidence:
Epidemiological, level III; Therapeutic, level IV.
Related Concept Videos
01:22Burn Injuries
The damage results in the death of skin cells, which can lead to a massive loss of fluid. Dehydration, electrolyte imbalance, and renal and circulatory failure follow, which can be fatal. Burn patients are treated with intravenous fluids to offset...
01:12Diffusion
01:21Diffusion
01:22Acute Kidney Injury I: Introduction
01:29Acute Kidney Injury II: Pathophysiology
01:22Acute Kidney Injury VI: Nursing Management