Vaidyanathan R.1 , Noor Rubina Ahamadi2 , Aravind R.M. 3 , Shivanand V.4 , Chandrashekar G.R.5
BACKGROUND Diffuse Axonal Injury (DAI) is one of the most common causes of post-traumatic coma, disability and a persistent neuro-vegetative state. We wanted to study the clinical profile, prognostic factors and long-term outcome of patients admitted with traumatic diffuse axonal injury in our ICU. METHODS 74 patients who were admitted to the ICU with diffuse axonal injury following brain trauma between Jan 2010 to Dec 2019 were included in the study. Baseline clinical assessment, GCS scoring, basic investigations including serology, complete blood count, and biochemistry, CT Brain along with x - ray of cervical spine, chest x - ray, x - ray pelvis and ultrasound abdomen was done for all patients. MRI brain was done for all patients with clinical suspicion of diffuse axonal injury within 36 hours of injury. All those patients with MRI proven diffuse axonal injury were included in the study. Patients who had significant parenchymal lesions in the brain in the form of contusions or haemorrhage in brain or those patients who underwent craniotomy were excluded from the study. All the patients were managed in ICU as per standard protocol of brain trauma foundation (BTF) guidelines. RESULTS Out of 74 patients, 65 required ventilatory support. There was no in-hospital mortality. The average length of ICU stay is 14.7 days which is directly related to the initial GCS score on admission and MRI grading of diffuse axonal injury. The lower GCS score and severe diffuse axonal injuries as shown by higher MRI grades were associated with longer duration of ICU stays. Presence of ventilator associated pneumonia (VAP) is a significant factor in determining the ICU stay and was seen in 35 % of the patients in our study. Major deficits as assessed by Glasgow outcome evaluation scale (GOC - E) at the end of one month post discharge was seen in 6 patients (8.1 %). However, at the end of 6 months, no significant motor deficits were seen in any of the patients. 2 patients died during the intervening 5 month follow up period due to unrelated causes. One patient was lost for follow up after one month. CONCLUSIONS The overall outcome in traumatic diffuse axonal injury is favourable with 0 % mortality as against a higher rate reported in available literature ranging from 30 – 70 %.1 Disability rate at the end of 6 months was also nil in our study compared to varied distribution of 20 – 40 % reported in the literature. Infections remain one of the biggest challenges in managing these cases. A ventilator associated pneumonia (VAP) incidence of 35 % was seen in our series.
