Is Diffuse Axonal Injury Different in Adults and Children? An Analysis of National Trauma Database.
Journal
Pediatric emergency care
ISSN: 1535-1815
Titre abrégé: Pediatr Emerg Care
Pays: United States
ID NLM: 8507560
Informations de publication
Date de publication:
01 Feb 2022
01 Feb 2022
Historique:
entrez:
1
2
2022
pubmed:
2
2
2022
medline:
3
2
2022
Statut:
ppublish
Résumé
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. 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. 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. Pediatric patients with DAI have improved outcomes and fewer associated injuries than adult counterparts.
Sections du résumé
BACKGROUND
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
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
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
CONCLUSIONS
Pediatric patients with DAI have improved outcomes and fewer associated injuries than adult counterparts.
Identifiants
pubmed: 35100742
doi: 10.1097/PEC.0000000000002626
pii: 00006565-202202000-00003
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
62-64Informations de copyright
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
Disclosure: The authors report no conflict of interest.
Références
Chelly H, Chaari A, Daoud E, et al. Diffuse axonal injury in patients with head injuries: an epidemiologic and prognosis study of 124 cases. J Trauma . 2011;71:838–846.
Mohammadipour A, Alemi A. Micromechanical analysis of brain’s diffuse axonal injury. J Biomech . 2017;65:61–74.
Henninger N, Compton RA, Khan MW, et al. “Don’t lose hope early”: hemorrhagic diffuse axonal injury on head computed tomography is not associated with poor outcome in moderate to severe traumatic brain injury patients. J Trauma Acute Care Surg . 2018;84:473–482.
Humble SS, Wilson LD, Wang L, et al. Prognosis of diffuse axonal injury with traumatic brain injury. J Trauma Acute Care Surg . 2018;85:155–159.
Ma J, Zhang K, Wang Z, et al. Progress of research on diffuse axonal injury after traumatic brain injury. Neural Plast . 2016;2016:9746313.
Frati A, Cerretani D, Fiaschi AI, et al. Diffuse axonal injury and oxidative stress: a comprehensive review. Int J Mol Sci . 2017;18:2600.
Kim M, Ahn JS, Park W, et al. Diffuse axonal injury (DAI) in moderate to severe head injured patients: pure DAI vs. non-pure DAI. Clin Neurol Neurosurg . 2018;171:116–123.
Linden VC, Verhelst H, Genbrugge E, et al. Is diffuse axonal injury on susceptibility weighted imaging a biomarker for executive functioning in adolescents with traumatic brain injury? Eur J Paediatr Neurol . 2019;23:525–536.
Mittl RL, Grossman RI, Hiehle JF, et al. Prevalence of MR evidence of diffuse axonal injury in patients with mild head injury and normal head CT findings. AJNR Am J Neuroradiol . 1994;15:1583–1589.
Taylor CA, Bell JM, Breiding MJ, et al. Traumatic brain injury–related emergency department visits, hospitalizations, and deaths—United States, 2007 and 2013. MMWR Surveill Summ . 2017;66:1–16.
Currie S, Saleem N, Straiton JA, et al. Imaging assessment of traumatic brain injury. Postgrad Med J . 2016;92:41–50.
Paterakis K, Karantanas AH, Komnos A, et al. Outcome of patients with diffuse axonal injury: the significance and prognostic value of MRI in the acute phase. J Trauma . 2000;49:1071–1075.
Thomas M, Dufour L. Challenges of diffuse axonal injury diagnosis. Rehabil Nurs . 2009;34:179–180.
Meythaler JM, Peduzzi JD, Eleftheriou E, et al. Current concepts: diffuse axonal injury-associated traumatic brain injury. Arch Phys Med Rehabil . 2001;82:1461–1471.
Smith DH, Meaney DF, Shull WH. Diffuse axonal injury in head trauma. J Head Trauma Rehabil . 2003;18:307–316.
van Eijck MM, Schoonman GG, van der Naalt J, et al. Diffuse axonal injury after traumatic brain injury is a prognostic factor for functional outcome: a systematic review and meta-analysis. Brain Inj . 2018;32:395–402.
Satapathy MC, Dash D, Mishra SS, et al. Spectrum and outcome of traumatic brain injury in children <15 years: a tertiary level experience in India. Int J Crit Illn Inj Sci . 2016;6:16–20.
Cordobés F, Lobato RD, Rivas JJ, et al. Post-traumatic diffuse axonal brain injury. Analysis of 78 patients studied with computed tomography. Acta Neurochir (Wien) . 1986;81(1–2):27–35.
Geddes JF, Hackshaw AK, Vowles GH, et al. Neuropathology of inflicted head injury in children. I. Patterns of brain damage. Brain . 2001;124(pt 7):1290–1298.
Keenan HT, Runyan DK, Marshall SW, et al. A population-based study of inflicted traumatic brain injury in young children. JAMA . 2003;290:621–626.
Parrish J, Baldwin-Johnson C, Volz M, et al. Abusive head trauma among children in Alaska: a population-based assessment. Int J Circumpolar Health . 2013;5:72.