Early prognosis after severe traumatic brain injury with minor or absent computed tomography scan lesions

Background: To assess the prognostic value of corpus callosumlesions (CCL) and brain stem lesions (BSL) in diffuse axonal injury (DAI) patients. Methods: From December 1989 to December 2008, 102 consecutive patients with pure DAI were admitted to our neurosurgical intensive care unit. Age, gender, Acute Physiology and Chronic Health Evaluation score, Glasgow Coma Score (GCS), pupillary light reactivity on admission, brain magnetic resonance imaging (MRI) 24 hours to 72 hours after trauma and sepsis, shock, adult respiratory distress syndrome, renal failure, neurosurgery, high intracranial pressure during the 6 months posttrauma were studied with multiple logistic regression, and Cox's proportional hazards, respectively, considering the Glasgow Outcome Scale and the time to recovery of consciousness as outcome variables. Results: Four variables predicted unfavorable Glasgow Outcome Scale (likelihood ratio p <0.0001; Area Under the Receiver Operator Curve (AUROC) = 0.92; Naglekerke's R² = 0.64; Goodness-of-Fit p = 0.8679): age (5-year odds ratio [OR], 1.44; 95% CI, 1.14-1.82; p = 0.002), bilateral absence of light reflexes (OR, 11.11; 95% CI, 2.19-57.67; p = 0.004), multiplicity of CCL (OR, 29.23; 95% CI, 7.06-121.01; p <0.001), and multiplicity of BSL (OR, 9.43; 95% CI, 2.44-36.42; p = 0.001). Four variables affected time to recovery of consciousness: age (hazard ratio, 0.98; 95% CI, 0.97-0.99; p = 0.009), bilateral absence of light reflexes (hazard ratio, 0.51; 95% CI, 0.27-0.97; p = 0.041), multiplicity of CCL (hazard ratio, 0.40; 95% CI, 0.25-0.66; p <0.001), and total GCS on admission (hazard ratio, 1.45; 95% CI, 1.23-1.71; p <0.001). Conclusions: In DAI patients, bad outcome is predicted by age, bilateral absence of pupillary light reflexes, multiplicity of CCL, and BSL on MRI. Time to recovery of consciousness is predicted by age, bilateral absence of light reflexes, multiplicity of CCL on MRI, and GCS on admission.