González Andrade, Fabricio
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Preferred name
González Andrade, Fabricio
Main Affiliation
Quito
Email
fabriciogonzalez@uti.edu.ec
ORCID
Scopus Author ID
8720668100

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Grading the damage: Prognostic significance of diffuse axonal injury severity and hemorrhagic lesions in traumatic brain injury outcomes

2025 , Nanci Estefanía Bayas-Almeida , González Andrade, Fabricio

Background: Diffuse axonal injury (DAI) is a key determinant of prognosis in traumatic brain injury (TBI), yet the interaction between DAI severity and associated hemorrhagic lesions is not well defined, especially in low- and middle-income countries (LMICs). Methods: We conducted a retrospective cohort study of 283 adults with moderate-to-severe TBI admitted to a tertiary hospital in Ecuador (2019–2023). DAI severity was graded anatomically using CT or MRI, and patients were stratified by the presence of hemorrhagic lesions. Demographic, clinical, metabolic, and radiological variables were collected. Outcomes were evaluated at 6 months with the Glasgow Outcome Scale–Extended (GOS-E). Logistic and ordinal regression models identified predictors of mortality and disability. Results: Of 283 patients, 141 had isolated DAI and 142 had DAI with hemorrhage. Baseline demographics were similar. Patients with hemorrhagic lesions had lower median Glasgow Coma Scale scores (6 vs 9, p < 0.001), more frequent hyperglycemia (15.5 % vs 7.1 %, p = 0.045), and greater surgical needs (77.5 % vs 16.3 %, p < 0.001). Complications, including pneumonia and central nervous system infections, were more frequent in the hemorrhagic group (63.9 % vs 45.7 %, p < 0.001). At 6 months, functional outcomes were significantly worse with hemorrhage (median GOS-E 7 vs 8, p < 0.001). Multivariable regression identified Grade III DAI as the strongest predictor of mortality (OR 20.02, 95 % CI 7.99–50.15) and disability (OR 71.59, 95 % CI 23.11–221.77). Hemorrhagic lesions predicted poor functional recovery (OR 2.08, 95 % CI 1.24–3.48) but not mortality. Conclusions: DAI grading is the most powerful prognostic factor in severe TBI, while hemorrhagic lesions primarily worsen disability. In LMICs, CT-based assessment remains essential for prognostic stratification and guiding rehabilitation strategies.

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Time-to-treatment in traumatic brain injury: unraveling the impact of early surgical intervention on patient outcomes

2025 , María Inés Egas Terán , González Andrade, Fabricio

Background: Traumatic brain injury (TBI) remains a major public health concern due to its high morbidity and mortality. The ‘golden hour’ principle suggests that outcomes improve with rapid access to definitive care. However, the role of prehospital transport time in TBI prognosis remains unclear, particularly in resource-limited settings. This study evaluates the relationship between hospital arrival time and functional prognosis in TBI patients. Methods: A cross-sectional observational study was conducted in two Ecuadorian trauma centers from 2017 to 2020. Patients were categorized into early (<8 h) and late (>8 h) hospital arrival groups. Demographic, clinical, radiological, and surgical variables were analyzed. The primary outcome was functional prognosis, measured by the Glasgow Outcome Scale (GOS) at hospital discharge. Logistic regression was used to adjust for confounding variables. Results: A total of 373 TBI patients were analyzed. The early-care group presented with more severe injuries, lower Glasgow Coma Scale (GCS) scores, and higher rates of abnormal pupillary responses. Late-arriving patients had better initial neurological status and were more likely to have received prehospital stabilization. Surgical intervention was delayed in both groups, with 67.8% of early-care patients undergoing surgery 8–24 h post-trauma. Adjusted analysis showed no significant difference in functional outcomes between early and late-care groups (OR 1.95, p = 0.08). Conclusion: Hospital arrival time alone does not significantly influence TBI outcomes. Instead, prehospital stabilization, initial GCS, and timely surgical intervention are stronger prognostic factors. Trauma care strategies should prioritize improving prehospital management and reducing in-hospital delays rather than strictly adhering to the ‘golden hour’ paradigm.

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