Correlates Of Clinical Manifestations With Severity And Prognosis In Patients With Diffuse Axonal Injury

Objective: to investigate the relationships of clinic manifestations with the severity and prognosis in patients with diffuse axonal injury, select the indices that can evaluate the severity accurately, create a predictive model of outcome in DAI patients.Method: 98 patients were selected from 157 DAI patients who were admitted in the First Affiliated Hospital Chongqing University of Medical Science during September 1998 to October 2006 according to research criteria. The clinical information of each patient was collected retrospectively. First, the patients were divided into 3 groups according to GCS on admission. Each clinical index was analyzed by Cochran-Mantel-Haenszelχ2 test or by one way analysis of variance in Student-Newman-Keuls test. Indices that indicated the severity were selected. Secondly, the patients were divided into 3 groups according to outcomes judged by GOS. The clinical indices that were related with outcome were singled out by Cochran-Mantel-Haenszelχ2 test or by one way analysis of variance in Student-Newman-Keuls test. And last, the indices which were related with outcome were analyzed by cumulative logit regression, in stepwise way.Result: 1.The indices, including unstable vital signs, abnormal pupil size and reactivity, decerebrate rigidity, motor disturbance, length of coma and the appearance of characteristic signs on imaging, were associated with GCS levels. Gender, age, injury mode, decorticate rigidity, pathologic reflexes and associated cerebral injuries were not correlated to GCS levels statistically. 2. The indices, including associated cerebral injuries, unstable vital signs, GCS on admission, abnormal pupil size and reactivity, decerebrate rigidity, motor disturbance, length of coma and the appearance of characteristic signs on imaging, were correlated with outcomes. No significant associations of gender, age, injury mode, decorticate rigidity and pathologic reflexes had no significant relations with outcome were found. 3. The logit regression model showed that GCS on admission, abnormal pupil size and reactivity, motor disturbance and associated cerebral injuries were the best predictors of outcome in DAI patients.Conclusion: 1.GCS level alone is not a proper indicator for the severity in DAI patients. The combination of GCS level with unstable vital signs, abnormal pupil size and reactivity, decerebrate rigidity, motor disturbance, length of coma and the appearance of characteristic signs on imaging can be a better way to evaluate the severity. 2. The logit regression model established in this study is a useful tool to predict the prognosis of DAI patients. Higher GCS on admission, normal pupil size and reaction, absence of motor disturbance and no associated cerebral injuries predict a better outcome.