Inpatient Outcomes in Pediatric Diffuse Axonal Injury: The Role of Severe TBI and Grade III DAI in Mortality and Morbidity

Introduction: Diffuse axonal injury (DAI) carries significant morbidity and mortality risks in adults, yet recent studies suggest pediatric patients may have a higher capacity for recovery. Understanding age-specific prognostic profiles in pediatric DAI is essential, but key factors remain understudied. This study uses national data to identify outcome predictors in pediatric DAI, offering insights to guide clinical decision-making and future research.

Methods: We analyzed pediatric DAI cases from the American College of Surgeons Trauma Quality Program (2019–2021), including patients under 18 and excluding those with intracranial hemorrhages or pre-hospital deaths. Demographic and clinical characteristics were compared across three age groups (0–3, 4–12, 13–17), and multivariate regression identified predictors of mortality, complications, intensive care unit (ICU) stay, and ventilator duration. Analyses were performed in Python 3.7 on Google Colab.

Results: Of 533 pediatric DAI patients, 20.3% died during hospitalization, with the highest mortality in the 0–3 age group (29.0%) (p = 0.016). Severe traumatic brain injury (TBI) (Glasgow Coma Scale 3–8) and hypotension (SBP < 90 mm Hg) were strong predictors of mortality (OR 56.9, p < 0.001; OR 9.2, p < 0.001). Prolonged coma duration (>24 hours) increased mortality odds (OR 7.4, p = 0.018) but was not significant in adjusted models. Complications occurred in 16.3% of patients, with severe TBI linked to a higher complication risk (OR 4.1, p = 0.005). ICU stay was longer for surgical patients (p < 0.001), and mechanical ventilation duration was predicted by coma duration (p < 0.001). Brainstem involvement, representing Grade III DAI, was not associated with worse outcomes.

Conclusion : Severe TBI and hypotension were significant predictors of mortality and complications in pediatric DAI. Interestingly, Grade III DAI was not linked to worse outcomes, suggesting the need for further research to refine prognostic models for this population.