Traumatic brain injury (TBI) is the leading cause of disability in children, affecting up to 500,000 children per year. Neuroimaging remains the standard of care in evaluation of TBI although its use in prognostication remains limited. MRI allows for detailed analysis of lesions caused by diffuse axonal injury (DAI), the hallmark pathology described in non-penetrating brain trauma. Imaging studies in pediatric TBI are limited by small sample size, heterogeneous population, varying imaging sequences, and time between injury and imaging.

Patients admitted to Stanford and Santa Clara Valley Medical Center for acute TBI were identified via retrospective chart review. Inclusion criteria were age < 19 years, blunt closed head trauma, MRI obtained during acute hospitalization. The first MRI (GRE or SWI) obtained during the acute hospitalization was used for the analysis of DAI grade. Short term outcome was discharge to acute rehabilitation. Long term outcome was PCPCS at 6-12 months.

108 patients were included. TBI severity was moderately correlated with DAI grade. Higher DAI grade was independently associated with discharge to rehab (p < 0.05) when controlling for GCS and age. Higher DAI grade in severe TBI patients was not associated with poor functional outcome.

DAI grading based on brain MRI was established in adult TBI and is frequently used for prognostication. Our preliminary data suggest that DAI grade can aide in predicting short term outcomes in pediatric patients. Further studies are needed to determine if additional MRI characteristics (non-hemorrhagic lesions on FLAIR and ADC) can be used to enhance prognostication both for short term as well as long term outcomes.