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Brain Inj. 2018;32(4):395-402. doi: 10.1080/02699052.2018.1429018. Epub 2018 Jan 30.

Diffuse axonal injury after traumatic brain injury is a prognostic factor for functional outcome: a systematic review and meta-analysis.

Author information

1
a Department of Neurology , Elisabeth-TweeSteden Hospital , Tilburg , The Netherlands.
2
b Trauma TopCare , Elisabeth-TweeSteden Hospital , Tilburg , The Netherlands.
3
c Department of Neurology , University of Groningen, University Medical Center Groningen , Groningen , The Netherlands.
4
d Department of Medical Psychology , Elisabeth-TweeSteden Hospital , Tilburg , The Netherlands.
5
e CoRPS, Department of Medical and Clinical Psychology , Tilburg University , Tilburg , The Netherlands.

Abstract

OBJECTIVE:

To determine the prognosis of adult patients with traumatic brain injury (TBI) and diffuse axonal injury (DAI).

METHODS:

Online search (PubMed, Embase and Ovid Science Direct) of articles providing information about outcome in (1) patients with DAI in general, (2) DAI vs. non-DAI, (3) related to magnetic resonance imaging (MRI) classification and (4) related to lesion location/load. A reference check and quality assessment were performed.

RESULTS:

A total of 32 articles were included. TBI patients with DAI had a favourable outcome in 62%. The risk of unfavourable outcome in TBI with DAI was three times higher than in TBI without DAI. Odds ratio (OR) for unfavourable outcome was 2.9 per increase of DAI grade on MRI. Lesions located in the corpus callosum were associated with an unfavourable outcome. Other specific lesion locations and lesions count showed inconsistent results regarding outcome. Lesion volume was predictive for outcome only on apparent diffusion coefficient and fluid attenuation inversion recovery MRI sequences.

CONCLUSIONS:

Presence of DAI on MRI in patients with TBI results in a higher chance of unfavourable outcome. With MRI grading, OR for unfavourable outcome increases threefold with every grade. Lesions in the corpus callosum in particular are associated with an unfavourable outcome.

KEYWORDS:

Diffuse Axonal Injury; Head Injury; Outcome; Traumatic Brain Injury

PMID:
29381396
DOI:
10.1080/02699052.2018.1429018
[Indexed for MEDLINE]

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