Diffuse Axonal Injury in Patients With Head Injuries: An Epidemiologic and Prognosis Study of 124 Cases
Diffuse Axonal Injury in Patients With Head Injuries: An Epidemiologic and Prognosis Study of 124 Cases
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DOI：
10.1097/ta.0b013e3182127baa
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发表时间：
2011-10-01
影响因子：
--
通讯作者：
Bouaziz, Mounir
中科院分区：
文献类型：
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作者：
Chelly, Hedi;Chaari, Anis;Bouaziz, Mounir
背景：弥漫性轴索损伤（DAI）通常与严重创伤有关。最近的成像技术进步使其诊断更加容易。其预后影响尚未很好地确定。本文的目的是描述创伤后DAI的流行病学、临床和放射学特征，并根据格拉斯哥结局量表研究其对死亡率和结局的预后影响。方法：这是一项为期4年（2004-2007）的124例头部外伤患者的回顾性研究。入院时和重症监护室期间记录人口学、临床、生物学和放射学检查结果。结果：平均年龄（±标准差）为28岁±15.8岁。颅脑ct扫描足以诊断31例DAI。105例患者进行磁共振成像，延迟7.7天+/- 8.6天。根据Gentry的分类，大多数患者分为II期（49.5%）或III期（44.8%）。在多因素分析中，与高死亡率相关的因素是自主神经异常（p = 0.018；优势比[OR] = 4.17）、重症监护病房入院时高血糖（p = 0.001; OR = 3.84）和硬膜下血肿(p = 0.031；OR = 3.99)，而根据格拉斯哥结局量表评分，与预后不良相关的因素是格拉斯哥昏迷量表评分< 8 (p = 0.032, OR = 3.55)，继发性全身损伤评分>= 3 (p = 0.034, OR = 2.83)，高血糖>= 8 mmol/L (p = 0.002, OR = 5.55)， DAI计数>= 6 （p = 0.035, OR = 3.33）。在纯DAI患者中，意识恢复缺失是死亡率的唯一独立因素（p < 0.001, OR = 116.4），而输血需求是预后不良的独立因素（p = 0.017, OR = 4.44）。结论：自主神经异常、高血糖和硬膜下血肿是DAI诊断时死亡率较高的主要因素，而DAI计数>= 6与预后不良相关。即使在单纯DAI患者中，磁共振成像分级也没有预后价值。
Background: Diffuse axonal injury (DAI) is usually associated to severe trauma. Recent imaging advances made its diagnosis easier. Its prognosis impact is not yet well established. The aim of this article is to describe the epidemiologic, clinical, and radiologic features of posttraumatic DAI and to study its prognosis impact on mortality and outcome according to Glasgow Outcome Scale.Methods: This is a retrospective study over a 4-year period (2004-2007) of 124 patients admitted for head trauma. Demographic, clinical, biological, and radiologic findings were recorded at admission and during intensive care unit stay.Results: Mean age (+/- standard deviation) was 28 years +/- 15.8 years. Cranial computed tomography scan was sufficient enough to diagnose DAI in 31 patients. Magnetic resonance imaging was performed in 105 patients with a delay of 7.7 days +/- 8.6 days. Most patients were classified as stage II (49.5%) or stage III (44.8%) according to Gentry's classification. In a multivariate analysis, factors associated with higher mortality were dysautonomia (p = 0.018; odds ratio [OR] = 4.17), hyperglycemia >= 8 mmol/L (p = 0.001; OR = 3.84) on intensive care unit admission, and subdural hematoma (p = 0.031; OR = 3.99), whereas factors associated to poor outcome according to Glasgow Outcome Scale score were Glasgow Coma Scale score < 8 (p = 0.032, OR = 3.55), secondary systemic injuries score >= 3 (p = 0.034, OR = 2.83), hyperglycemia >= 8 mmol/L (p = 0.002, OR = 5.55), and DAI count >= 6 (p = 0.035, OR = 3.33). In patients with pure DAI, the absence of consciousness recovery was the unique independent factor of mortality (p < 0.001, OR = 116.4), whereas only transfusion need was an independent factor of poor outcome (p = 0.017, OR = 4.44).Conclusion: Dysautonomia, hyperglycemia, and subdural hematoma are the main factors associated to higher mortality when DAIs are diagnosed, whereas a DAI count >= 6 is associated to poor outcome. Magnetic resonance imaging classification did not have a prognosis value even in patients with pure DAI.