Patients with diffuse axonal injury can recover to a favourable long term functional and quality of life outcome

Functional outcome and quality of life are difficult to predict in patients with diffuse axonal injury (DAI) after traumatic brain injury (TBI). The primary aim of this cross-sectional cohort study was to assess the long-term functional outcome in patients with DAI and to identify prognostic factors. Secondly, health-related quality of life (HRQL) at long-term follow-up was assessed. Patients aged ≥16 with TBI and DAI (admitted 2008-2014) were included. Clinical and imaging data were collected. The primary outcome parameter was the Glasgow Coma Scale Extended (GOSE) at long-term follow-up. Secondly, the HRQL was assessed with the Quality Of Life after Brain Injury (Qolibri) questionnaire. DAI was diagnosed in 185 patients. Long-term functional outcome was obtained in 134 patients (72%), median follow-up 54 months (range 14-100). 51% had a favourable outcome (GOSE 6-8). Independent prognostic factors were age, pupillary reaction, Hb, DAI grading, and return of consciousness ≤7 days. Sixty-two percent had a good HRQL, after a median follow-up of 57 months (range 14-100) with age as an independent prognostic factor. More than half of patients with DAI had a favourable functional outcome and a good HRQL at long-term follow-up. Also in patients with a DAI grade 3 a favourable outcome was seen. HRQL is a clinically relevant outcome measure since it reflects perceived outcome by patients. Independent prognostic variables for the functional outcome were factors obtained in the acute phase after injury, whereas age was an independent prognostic factor for HRQL.