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J Trauma Inj : Journal of Trauma and Injury



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2 "Diffuse axonal injury"
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Clinical Outcomes of Diffuse Axonal Injury According to Radiological Grade
Hak-Jae Lee, Hyun-Woo Sun, Jae-Seok Lee, Nak-Joon Choi, Yoon-Joong Jung, Suk-Kyung Hong
J Trauma Inj. 2018;31(2):51-57.   Published online August 31, 2018
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  • 5 Citations
AbstractAbstract PDF

Patients with diffuse axonal injury experience various disabilities and have a high cost of treatment. Recent researches have revealed the underlying mechanism and pathogenesis of diffuse axonal injury. This study aimed to investigate the correlation between the radiological grading of diffuse axonal injury and the clinical outcomes of patients.


From January 2011 to December 2016, among 294 patients with traumatic brain injury, 44 patients underwent magnetic resonance imaging (MRI). A total of 18 patients were enrolled in this study except for other cerebral injuries, such as cerebral hemorrhage or hypoxic brain damage. Demographic data, clinical data, and radiological findings were retrospectively reviewed. The grading of diffuse axonal injury was analyzed based on patient’s MRI findings.


For the most severe diffuse axonal injury patients, prolonged intensive care unit (ICU) stay (p=0.035), hospital stay (p=0.012), and prolonged mechanical ventilation (p=0.030) were observed. However, there was no significant difference in healthcare-associated infection rates between MRI grading (p=0.123). Massive transfusion, initial hemoglobin and lactate levels, and MRI gradings were found to be highly significant in predicting the duration of unconsciousness.


This study showed that patients with high grade diffuse axonal injury have prolonged ICU stays and significantly longer hospital stays. Deteriorated mental patients with high energy injuries should be evaluated to identify diffuse axonal injuries by using an appropriate imaging tool, such as MRI. It will be important to predict the duration of consciousness recovery using MRI scans.



Citations to this article as recorded by  
  • Prediction for the prognosis of diffuse axonal injury using automated pupillometry
    Makoto Murase, Shinichi Yasuda, Makoto Sawano
    Clinical Neurology and Neurosurgery.2024; 240: 108244.     CrossRef
  • Head CT for the intensivist: 10 tips and pearls
    Sajeev A. MAHENDRAN, Oliver FLOWER, J. Claude HEMPHILL III rd
    Minerva Anestesiologica.2022;[Epub]     CrossRef
  • Evaluation of Laboratory Variables Related to Diffuse Axonal Injury: A Cross-sectional Study
    Masoud Hatefi, Khalil Komlakh
    Archives of Neuroscience.2022;[Epub]     CrossRef
  • Clinical outcomes of diffuse axonal injury after traumatic brain injury according to magnetic resonance grading
    Insu Lee, Kawngwoo Park, Tae Seok Jeong, Woo-Seok Kim, Woo Kyung Kim, Do Yeon Rhee, Cheol Wan Park
    Journal of Korean Society of Geriatric Neurosurger.2021; 16(2): 71.     CrossRef
  • Use of Magnetic Resonance Imaging in Acute Traumatic Brain Injury Patients is Associated with Lower Inpatient Mortality
    Hwan Lee, Yifeng Yang, Jiehui Xu, Jeffrey B. Ware, Baogiong Liu
    Journal of Clinical Imaging Science.2021; 11: 53.     CrossRef
Prognostic Value of Computed Tomography and Gradient-echo Magnetic Resonance Imaging in Diffuse Axonal Injury
Nam Ki Jung, Sang Chan Jin, Woo Ik Choi
J Trauma Inj. 2012;25(4):122-131.
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  • 5 Download
AbstractAbstract PDF
Diffuse axonal injury (DAI) is clinically defined as a coma of over six hours in a head trauma victim without a focal mass lesion. The emergency physician usually resuscitates and stabilizes a comatose head trauma victim in the emergency Department. After assessment and treatment, the prognosis is very important to both the victim and the physician. The prognosis for DAI is based on Glasgow Coma Scale (GCS) and other imaging data. We investigated the prognostic value of computed tomography (CT) and gradient-echo magnetic resonance imaging (GRI) for head trauma victims with DAI.
Fifty-three(53) head trauma victims of DAI were enrolled in this study from 2007 to 2012. During the study period of six years, data on trauma victims were collected retrospectively. We analyzed the differences in the Glasgow Outcome Scale (GOS) result between the CT and the GRI modalities.
We classified the study group by using GOS. Between the good outcome subgroup (GOS scores of 4 and 5) and the poor outcome subgroup (GOS score of 1-3), there were no statistical difference in sex, age, initial vital signs and initial GCS score. The good outcome subgroup had non-hemorrhage on CT(52%), which was correlated with good outcome and a shorter awakening time, while a larger number and a deeper location of hemorrhagic lesions on in GRI were correlated with poor outcome in DAI.
We conclude that the existence of hemorrhagic lesions on CT, and the number and location of those lesions on GRI had good prognostic value for head trauma victims with DAI.

J Trauma Inj : Journal of Trauma and Injury