Is Diffuse Axonal Injury Different in Adults and Children? An Analysis of National Trauma Database

Abstract

Background: Diffuse axonal injury (DAI) is typically associated with significant mechanisms of injury and the effects of acceleration-deceleration forces on brain tissues. The prognosis of DAI remains a matter of active investigation, but little is known about outcome differences between adult and pediatric populations with DAI. Methods:We performed a retrospective cohort study involving blunt trauma patients with DAI between the years 1997 and 2018 from the Israeli National Trauma Registry. The patients were divided to pediatric (age <15 years) and adult (age >15 years) groups, with subsequent comparison of demographics and outcomes.Results: Diffuse axonal injury was identified in 1983 patients, including 469 pediatric victims (23.6%) and 1514 adults (76.4%). Adults had higher Injury Severity Score (20.5% vs 13.2%, P = 0.0004), increased mortality (17.7% vs 13.4%, P < 0.0001), longer hospitalizations (58.4% vs 44.4%, P < 0.001), and higher rehabilitation need rates (56.4% vs 41.8%, P < 0.0001). Associated extracranial injuries were also more common in adults, particularly to the chest.Conclusions: Pediatric patients with DAI have improved outcomes and fewer associated injuries than adult counterparts.

Traumatismo craneoencefálico en adultos jóvenes: una serie de casos y análisis de su pronóstico

“…Un análisis, una base de datos importante el National Trauma Database israelí en un estudio de cohorte retrospectivo donde identificó lesión axonal difusa en pacientes pediátricos (23,6%) y adultos (76,4%). Los adultos tenían una puntuación de gravedad de lesiones más alta (20,5 % frente a 13,2 %) con mayor mortalidad (17,7 % frente a 13,4 %), hospitalizaciones más prolongadas (58,4 % frente a 44,4 %) y mayor necesidad de rehabilitación (56,4 % frente a 41,8 %) (19). Un grado más alto de lesión axonal difusa, observado en la resonancia magnética temprana realizada, se asocia con un peor resultado funcional a los 6 meses y mayor necesidad de rehabilitación hospitalaria en niños con traumatismo craneoencefálico grave (20).…”

Evaluation of Laboratory Variables Related to Diffuse Axonal Injury: A Cross-sectional Study

“…This is consistent with our results indicating that the number of male DAI patients is high compared to females. Since the most important causes of TBI include traffic accidents, conflicts, and falls, males are more exposed to such injuries due to their job type and environment (33,34). Also, 65% of DAI patients had GCS less than 7 and the GCS range was between 3 and 13 for all patients.…”

Acute Computer Tomography Findings in Pediatric Accidental Head Trauma-Review

“…DAIs usually have bad prognosis, but in paediatric population the outcome seems better than in the adults. 47 …”

“…DAIs usually have bad prognosis, but in paediatric population the outcome seems better than in the adults. 47 Intracerebral haemorrhage (ICH)) is an accumulation of blood in the white matter of the brain after the rotational forces tear intraparenchymal blood vessels (be they arteries or veins). The most common sites are the frontotemporal areas and basal ganglia.…”