Analysis of late functional recovery after moderate to severe traumatic brain injury (TBI) with diffuse axonal injury (DAI)

Abstract

Introduction: Traumatic brain injury (TBI) is a medical and social condition of high importance that annually affects 65.5/100,000 inhabitants in Brazil. Diffuse Axonal Injury (DAI) is a severe form of TBI secondary to axonal stretching and rupture, being considered the main determinant of morbidity and mortality in TBI victims. Despite its importance, there are no studies on late outcomes after LAD in Brazilian patients, and the current literature on LAD is restricted to follow-ups d 1 year and in populations from developed countries, not reflecting the epidemiological reality of Brazil and other developing countries. Objectives: The primary objective of this study is to describe the late clinical outcome (e 7 years post-TBI) of patients with LAD using the Glasgow Outcome Scale Extended (GOSE) scale. Secondary objectives include: assessing the degree of cognitive recovery using the Rancho de Los Amigos Scale (RLAS); assess the degree of independence for self-care through the Functional Independence Measure (FIM); and to assess, in patients who need a caregiver at the time of evaluation, the degree of caregiver burden using the Zarit Burden Interview (ZBI) instrument. Methods: this study will be a retrospective cohort of patients with moderate-severe TBI and presumed diagnosis of DAI admitted consecutively, from Mar 2012 to Jan 2015, in a specialized trauma ICU. Patients aged 16-65 years at the time of trauma, diagnosis of moderate-severe TBI on admission and imaging and clinical findings suggestive of LAD were included. Individuals with previous episodes of TBI or disabling neurological disease were excluded. Late clinical outcomes will be evaluated from May 2022 to August 2022 using the GOSE, RLAS, MIF and ZBI scales.