Kim Moinay, Hong Suk Kyung, Jeon Sang Ryong, Roh Sung Woo, Lee Seungjoo
Asan Medical Center, University of Ulsan College of Medicine, Department of Neurological Surgery, Seoul, Republic of Korea.
Turk Neurosurg. 2022;32(1):6-15. doi: 10.5137/1019-5149.JTN.28132-19.4.
To evaluate diffuse axonal injury (DAI) patients according to DAI stage to identify risk factors that may affect clinical outcome.
A total of 992 traumatic brain injury (TBI) patients visited our hospital between 2011 and 2016. Thirtyseven patients diagnosed with DAI were enrolled in this study and stratified by DAI stage: Stage I, 20 patients (54.1%); Stage II, 4 patients (10.8%); and Stage III, 13 patients (35.1%).
The mean age and the median follow-up period were 45.43 years and 13 months, respectively. Patient demographic data and clinical findings on admission showed no differences according to DAI stage, except for the revised trauma score (RTS) (p=0.026). In univariate analysis, stages I and II vs. III (p=0.001) and stages I vs. II and III (p=0.019), transfusion within 24 hours of visit (p=0.033), shock or cardiac arrest (p=0.006), traumatic subarachnoid hemorrhage (T-SAH) (p=0.011), and subdural hematoma (SDH) (p=0.009) were significantly correlated with Glasgow outcome score (GOS). In multivariate analysis, DAI stage I and II vs. III (p=0.005) and SDH (p=0.040) were significant.
Clinically, Stage II was more correlated with Stage I, rather than stage III. Stage III showed a much poorer outcome compared to stages I and II. Magnetic resonance imaging (MRI) should be promptly performed in all TBI patients when a patient?s level of consciousness and cranialcomputed tomography (CT) does not match, as there is a possibility of stage III DAI.
根据弥漫性轴索损伤（DAI）分期对DAI患者进行评估，以确定可能影响临床结局的危险因素。
2011年至2016年间共有992例创伤性脑损伤（TBI）患者到我院就诊。37例诊断为DAI的患者纳入本研究，并根据DAI分期进行分层：I期，20例（54.1%）；II期，4例（10.8%）；III期，13例（35.1%）。
平均年龄和中位随访期分别为45.43岁和13个月。患者的人口统计学数据和入院时的临床检查结果，除改良创伤评分（RTS）外（p=0.026），根据DAI分期无差异。单因素分析中，I期和II期与III期相比（p=0.001）以及I期与II期和III期相比（p=0.019）、就诊后24小时内输血（p=0.033）、休克或心脏骤停（p=0.006）、创伤性蛛网膜下腔出血（T-SAH）（p=0.011）和硬膜下血肿（SDH）（p=0.009）与格拉斯哥预后评分（GOS）显著相关。多因素分析中，DAI I期和II期与III期相比（p=0.005）以及SDH（p=0.040）具有显著性。
临床上，II期与I期的相关性比与III期的更强。与I期和II期相比，III期的结局要差得多。当患者的意识水平与头颅计算机断层扫描（CT）不相符时，所有TBI患者均应立即进行磁共振成像（MRI）检查，因为有可能存在III期DAI。
