Factors Predicting Lung Contusions in Critically Ill Trauma Children: A Multivariate Analysis of 330 Cases.

PURPOSE: The aim of the study was to identify factors predicting lung contusion in trauma children. METHODS: Retrospective study conducted for a period of 8 years (January 01, 2005-December 31, 2012) in a medical surgical intensive care unit. All trauma patients younger than 15 years were included. Two groups were compared: those with lung contusions (C+ group) and those without lung contusions (C- group). RESULTS: We included 330 patients. The mean (SD) age was 7.6 (4.3) years. Chest injury was diagnosed in 70 patients (21.2%). All our patients needed mechanical ventilation. Lung contusions were diagnosed in 43 patients (13% of all patients and 61.4% of patients with chest trauma). In multivariate analysis, independent factors predicting lung contusion were road traffic accident (odds ratio [OR], 3.2; 95% confidence interval [CI], 1.2-8.6; P = 0.019), increased Pediatric Risk of Mortality (PRISM) score (OR, 1.1; 95% CI, 1.1-1.2; P = 0.017), hepatic contusion (OR, 4.8; 95% CI, 1.3-17.1; P = 0.017), and pelvic ring fracture (OR, 3.5; 95% CI, 1.1-10.5; P = 0.026). Death occurred in 46 patients (13.9%). Intensive care unit mortality was significantly higher in the C+ group (OR, 2.5; 95% CI, 1.2-5.4; P = 0.021). However, mortality was not different between the 2 groups after adjusting for PRISM score (OR, 1.2; 95% CI, 0.5-2.9; P = 0.752) or after adjusting for Injury Severity Score (OR, 0.7; 95% CI, 0.3-2.1; P = 0.565). CONCLUSIONS: Lung contusion is common in critically ill children with chest trauma. The diagnosis should be considered in patients with road traffic accident, increased PRISM score, hepatic contusion, and pelvic ring fracture.

Effectiveness of Systemic Fluconazole in Adult Patients With Asymptomatic Candiduria: A Systematic Review and Meta-Analysis.

Asymptomatic candiduria is a common finding in hospitalized patients. Its management modalities are still a matter of debate. Urinary catheter should be removed or replaced in all cases. In the current meta-analysis, we aimed to compare 2 different strategies in term of candida clearance from the urinary tract: Systemic fluconazole versus conservative management. A systematic search was performed in Pubmed, Web of science, and Cochrane Library database by 2 investigators. Three studies were included (421 patients). Data were extracted and the quality of each study was assessed. Systemic fluconazole was associated with a significantly higher short-term clearance of the funguria after 14 days of treatment [odds ratio = 0.43; confidence interval (CI) 95% (0.26-0.65)]. No significant heterogeneity was found among the included studies (Q statistic test = 0.38; I = 0). In conclusion, fluconazole significantly hasten short-term candida clearance from the urinary tract.

Value of Serum Cholinesterase Activity in the Diagnosis of Septic Shock Due to Bacterial Infections.

BACKGROUND: We aimed to investigate whether serum cholinesterase (SChE) activity can be helpful for the diagnosis of septic shock and to evaluate its usefulness in comparison with procalcitonin (PCT) and C-reactive protein (CRP). METHODS: A prospective single-blinded study conducted in an intensive care unit of university hospital. Patients were classified as having cardiogenic shock, septic shock, or hemorrhagic shock. We also included a control group without neither hemodynamic instability nor sepsis. For all included patients, SChE, PCT, and CRP were simultaneously sampled. RESULTS: The comparison of sepsis markers between all groups showed that the mean values of PCT and CRP were significantly higher in patients with septic shock. However, SChE activity was significantly lower in this group. The SChE activity was found to be more accurate than PCT and CRP for the diagnosis of septic shock. In fact, an SChE activity ≤ 4000 UI/L predicted the diagnosis of septic shock with a sensitivity of 78%, a specificity of 89%, a predictive negative value of 97%, and a predictive positive value of 65%. However, the prognostic value of SChE activity was poor in multivariate analysis. CONCLUSION: The SChE activity level was significantly decreased in patients with septic shock. However, its prognostic value is poor. Our results suggest that SChE activity is useful for the diagnosis of septic shock. Further studies are warranted to confirm our findings.

Amniotic fluid embolism complicating medical termination of pregnancy.

BACKGROUND: Amniotic fluid embolism is always a severe complication and generally occurs during labour or immediately after childbirth. CLINICAL FEATURES: We report the case of a patient falling victim to amniotic fluid embolism after the medical termination of her pregnancy at 24 weeks of amenorrhea following the discovery of a teratoma-carrying foetus. The amniotic fluid embolism diagnosis was strongly suspected in the face of the sudden onset of severe arterial hypotension, hypoxic respiratory distress, a coma state and disseminated intravascular coagulopathy immediately after the delivery. Additional tests were conducted to support the diagnosis: cytological testing of a peripheral venous sample and maternal broncho-alveolar lavage fluid, dosing of tryptase and alpha-fetoprotein levels as well as screening for insulin-like growth factor binding protein 1. CONCLUSION: Amniotic fluid embolism is a rare and difficult diagnosis, especially in unconventional settings, yet it can be facilitated by screening for amniotic markers and tryptase.

Epidemiological features of stress hyperglycemia in elderly at emergency department.

UNLABELLED: Background : Stress hyperglycemia among patients having an acute pathology is frequently described in recent studies. AIMS: The objectives of this work were to describe epidemiologic features of elderly patients hospitalized in the emergency department and having a hyperglycemia due to stress. METHODS: A retrospective chart review identified patients older than 65 years with obtained serum glucose levels. Patients with diabetes were excluded. Two levels of serum glucose were considered (>6,9 mmol/l and ≤ 6,9 mmol/l).   RESULTS: We included 165.  There were 94 patients with high level of serum glucose level (56,9%). Multivariate analysis found that only cardio-vascular pathologies were more predictive of having stress hyperglycemia (p=0,014, odds-ratio=2,8, IC=1,2-6,4). There were no correlation between serum glucose levels and mortality. CONCLUSION: Stress hyperglycemia is a fairly common disorder but underestimated in emergency department. Its impact on the prognosis of elderly patients remains to be studied.

Recovering the size of nanoparticles by digital in-line holography.

The development of methods to measure the size of nanoparticles is a challenging topic of research. The proposed method is based on the metrology of the stable vapor bubble created by thermal coupling between a laser pulse and the nanoparticle in a droplet. The measurement is realized by digital in-line holography. The size of the nanoparticle is deduced from numerical simulations computed with a photo-thermal finite element method.

Does low-dose hydrocortisone therapy prevent ventilator-associated pneumonia in trauma patients?

The incidence of ventilator-associated pneumonia (VAP) is particularly high in trauma patients. Immediate acute inflammation response is one of the hallmarks of multiple trauma. This phenomenon is associated with an immunosuppression state and may increase the risk of VAP. In our study, we aimed to evaluate whether low-dose steroids prevent VAP onset in multiple trauma patients. All adult patients admitted in our intensive care unit (ICU) for multiple trauma with predicted duration of mechanical ventilation over 48 hours were included. We compared 2 different periods: a retrospective cohort of patients who did not receive low-dose steroids for VAP prevention and a prospective cohort of patients who received hydrocortisone with a dose of 100 mg/8 hours for a scheduled period of 7 days. We included 175 patients: 92 in the steroids (-) group and 83 in the steroids (+) group. The incidence of VAP was not different between the 2 studied groups (29.3% and 26.5%; P = 0.676). When predictive factors of VAP onset were studied in multivariate analysis, steroids had no preventive effect on VAP [OR = 1.6; 95% confidence interval, 0.73-3.6; P = 0.234]. We did not find any difference between the 2 groups, neither in terms of ICU length of stay (respectively, 11 ± 9.7 days vs. 12.3 ± 10.7 days; P = 0.372) nor in terms of ICU mortality (29.3% vs 24.1%; P = 0.434).

Neurogenic pulmonary edema after severe head injury: a transpulmonary thermodilution study.

Neurogenic pulmonary edema (NPE) is a possible complication of severe central nervous system insult. Its physiopathology is still debated. We report a fatal case of a 55-year-old man who was admitted because of severe head injury. The diagnosis of NPE was considered according to clinical and radiologic findings. Transpulmonary thermodilution study showed decreased stroke volume index and cardiac function index. Indexed extravascular lung water was increased as well as pulmonary vascular permeability index. The impairment of the left ventricular function was confirmed by the echocardiographic study. Our case suggests that NPE imply both cardiac dysfunction and lung injury. Thus, transpulmonary thermodilution can be helpful in managing fluid balance and the choice of vasopressors in patients with life-threatening NPE.

Does selective digestive decontamination prevent ventilator-associated pneumonia in trauma patients?

The incidence of ventilator-associated pneumonia (VAP) is particularly high in patients with trauma. The efficacy and safety of selective digestive decontamination (SDD) was not studied extensively. We aimed in our randomized double-blind, placebo-controlled study to evaluate whether SDD prevents VAP onset in multiple trauma patients. All adult patients admitted in our intensive care unit for multiple trauma with a predicted duration of mechanical ventilation (MV) over 48 hours were included. We included 44 patients who were divided into 4 groups: group A receiving subglottic and gastric treatment suspension (polymyxin E 100 mg, vancomycin 1 g, and amphotericin B 500 mg), group B receiving placebo, group C receiving subglottic placebo and gastric treatment suspension, and group D receiving subglottic treatment suspension and gastric placebo. The suspension was given 4 times a day during 7 consecutive days. To this topical treatment, we associated an intravenous administration of cefotaxime (1 g 3 times a day during 4 consecutive days). The incidence of VAP in the 4 groups was, respectively, 45.5%, 46.2%, 22.2%, and 27.3% (P=0.236). In multivariate analysis, none of the 3 tested regimens was identified as a protective factor against VAP. However, prolonged duration of MV was the only independent factor predicting VAP onset (odds ratio=1.1; 95% confidence interval [1.1-1.4]; P=0.049).

Impact of hydrocortisone hemisuccinate use on outcome of severe scorpion-envenomed adult patients.

The aim of this study is to analyze if the infusion of hydrocortisone hemisuccinate improve outcome in severe scorpion-envenomated adult patients admitted to intensive care unit (ICU). Pairwise retrospective case-control study with 1:1 matching was designed. Patients were defined as cases when they received hydrocortisone hemisuccinate (as alone steroids) during hospitalization and as controls when they did not received any steroids. Patients were matched according to age, severity factors at admission represented by the presence of pulmonary edema and grades of severity of scorpion envenomation, and scorpion antivenom administration. Eighty-four patients were included as follows: 42 patients in the cases group and 42 patients in the control group. The mean age (±SD) was 40±21 years, ranging from 16 to 90 years. Moreover, 67 (80%) patients have a systemic inflammatory response syndrome on ICU admission. The comparison between cases group and control group showed that age is not significantly different. There were the same proportions of patients with pulmonary edema in 2 groups. Moreover, 23 (54%) patients in case group and 23 (54%) in the control group received scorpion antivenom (P>0.05). The mean temperature on admission was also not significantly different. The presence of systemic inflammatory response syndrome was again not significantly different between 2 groups. The comparison of outcome of the 2 groups showed that the use of mechanical ventilation and its duration, the ICU stay length, and ICU mortality was not significantly different between the 2 groups. Although our study has some limitations, it confirms that the use of hydrocortisone hemisuccinate in severe scorpion-envenomed patients did not improve their outcome.

Does change of catecholamine use improve the outcome of patients with shock admitted to intensive care unit?

Up to 2008, dopamine was the catecholamine that was the most recommended in our intensive care unit (ICU) after fluid resuscitation. However, recently, norepinephrine has become the catecholamine that was most recommended in our ICU after fluid resuscitation. The aim of this study was to determine if there was an efficacy or safety benefit to this protocol therapeutic change in patients with shock admitted to our ICU. The primary outcome variable was ICU mortality. This is a prospective observational study conducted in 2 periods in our ICU (Habib Bourguiba University Hospital, Sfax, Tunisia). During the 2 study periods, 251 patients were included. There were 130 patients in group 1 and 121 patients in group 2. There were no significant differences between the 2 groups with regard to most of the baseline characteristics. The comparison between the 2 groups showed that in the first period, dopamine was the catecholamine that was the most used. However, in the second period, norepinephrine is the catecholamine that was most used. When we analyzed the catecholamine prescription in septic shock, we concluded that in the first study period, dopamine was used as the catecholamine as the first choice in 85.7% of cases (P < 0.001), and norepinephrine is the first choice in 100% of cases in the second period. In cardiogenic shock, in the first study period, dobutamine was used as the catecholamine as the first choice in 61% of cases (P < 0.001) and norepinephrine is the first choice in 43% of cases in the second period. Finally, in hypovolemic shock, dopamine was used as the catecholamine as the first choice in 68% of cases in group 1 and norepinephrine is the first choice in 88% of cases in the second period (P < 0.001). During the ICU stay, some adverse events related to catecholamine use were observed. The occurrence of arrhythmias was significantly more frequent in the first group. Mortality rate was at 51% in the first group and 44% in the second group (P = 0.27). The mortality rate was not significantly different for each type of shock (septic, cardiogenic, and hypovolemic) in both groups (P > 0.05 for all), although the occurrence of arrhythmias was significantly more frequent in the first group, in clinical practice, our study confirms that the rate of death did not differ significantly between the 2 groups of patients mostly treated with dopamine (group 1) and the group mostly treated with norepinephrine.

Numerical modeling of the photothermal processing for bubble forming around nanowire in a liquid.

An accurate computation of the temperature is an important factor in determining the shape of a bubble around a nanowire immersed in a liquid. The study of the physical phenomenon consists in solving a photothermic coupled problem between light and nanowire. The numerical multiphysic model is used to study the variations of the temperature and the shape of the created bubble by illumination of the nanowire. The optimization process, including an adaptive remeshing scheme, is used to solve the problem through a finite element method. The study of the shape evolution of the bubble is made taking into account the physical and geometrical parameters of the nanowire. The relation between the sizes and shapes of the bubble and nanowire is deduced.

Nosocomial dissemination of Providencia stuartii isolates carrying bla OXA-48, bla PER-1, bla CMY-4 and qnrA6 in a Tunisian hospital.

OBJECTIVES: To report an outbreak due to Providencia stuartii isolates carrying bla(OXA-48), bla(PER-1), bla(CMY-4) and qnrA6 in a Tunisian hospital in 2011. METHODS: Eight intensive care unit (ICU) patients infected/colonized by extended-spectrum ß-lactamase (ESBL)-producing P. stuartii between March and May 2011 were included. Molecular epidemiology was studied by PFGE. Antibiotic resistance genes were analysed by PCR and sequencing and the plasmid incompatibility group by a PCR-based replicon typing scheme. RESULTS: Eight patients were colonized with ESBL-producing P. stuartii isolates. All these isolates were clonally related and found to carry bla(OXA-48), bla(PER-1), bla(CMY-4), qnrA6 and aac-6'-Ib genes on the same self-conjugative IncA/C plasmid. The same strain was also cultured from environmental samples in the ICU. All these isolates were susceptible to carbapenems. Only one colonized patient developed P. stuartii pleurisy and was effectively treated with imipenem alone. CONCLUSIONS: This is the first report of an outbreak due to P. stuartii isolates carrying bla(OXA-48) in Tunisia. The simultaneous expression of various resistance genes (bla(OXA-48), bla(CMY-4), bla(PER-1), qnrA and aac-6'-Ib) by P. stuartii isolates is alarming.

Nanobubble evolution around nanowire in liquid.

The evolution of the shape and size of a bubble around a nanowire immersed in a liquid can be studied as a light absorption problem and consequently can directly be related to the distribution of the temperature around the nanowire. Such a physical phenomenon can be seen as the photo-thermal coupled problem of nanowire illuminated by an electromagnetic wave. The resolution of the multiphysic model allows to compute the variation of the temperature and consequently the evolution of the created bubble. An advanced adaptive remeshing process is developed to solve the numerical model using Finite Element Method. An optimization process is applied to solve the coupled problem and is used to detect the size of the produced bubble around nanowire under illumination. The adaptive remeshing process permits to control the convergence of the numerical solution relatively to the evolution of the temperature field. The process allows to study the evolution of the shape and size of the bubble. We show the influence of the laser parameters on the evolution of the bubble. The informations about the geometry of the nanowire can be deduced from the size and shape of the bubble.

Efficacy of corticosteroid therapy in severe decompensation of chronic obstructive pulmonary disease requiring mechanical ventilation.

The purpose of this study was to analyze the efficacy of corticosteroids in severe acute decompensation of chronic obstructive pulmonary disease requiring mechanical ventilation and intensive care unit (ICU) admission. Pairwise retrospective case-control study with 1:1 matching. Patients were defined as cases when they received corticosteroids and as controls when they did not received any steroids. Patients were matched according to age, severity factors at admission represented by the PaO2/FiO2 ratio, and simplified acute physiology score. Thirty-four patients were included. There were 17 patients in the case group and 17 patients in the control group. There were 27 men (80%) and 7 women (20%). The mean age (±SD) was 70 ± 9 years with a range of 40-85 years. Thirty-two patients (94 %) were older than 60 years. The comparison between the 2 groups showed that they had the same epidemiological, clinical, and biological findings on ICU admission. Homodynamic parameters were also not significantly different between the 2 groups. Moreover, there is the same proportion of invasive mechanical ventilation use in 2 groups. Concomitant drugs used were also not significantly different between the 2 groups. Finally, the comparison of outcome between the steroid and steroid-free groups showed that mortality rate was not significantly different (64% vs. 58%, P = 0.72). However, systemic corticosteroid therapy was associated with a significant increase in a reduction in the duration of mechanical ventilation (P = 0.004) and a trend toward a shorter length of ICU stay (P = 0.053). Although the authors detected no significant difference in mortality rate at the time of discharge between steroid and streroid-free patients, this study confirms that systemic corticosteroid therapy in patients with chronic obstructive pulmonary disease exacerbations requiring mechanical ventilation is associated with a significant reduction in the duration of mechanical ventilation. Other studies are needed on this subject.

Acute renal failure and pregnancy: a seventeen-year experience of a Tunisian intensive care unit.

PURPOSE: To describe the epidemiologic features of acute renal failure related to pregnancy (PRARF) and to evaluate its prognostic impact. METHODS: Retrospective study conducted in a Tunisian intensive care unit over a period of 17 years (1995-2011). Women were included if they were more than 20 weeks pregnant and were admitted to the ICU during pregnancy or immediately (<7 d) post partum. PRARF was defined by a serum creatinine level >0.8 mg/dL and was classified as mild (0.9 to 1.4 mg/dL), moderate (1.5 to 2.9 mg/dL) or severe (>3 mg/dL). RESULTS: Five hundred and fifty patients were included. Mean age was 31 ± 6 years. Mean SOFA score was 4 ± 3. PRARF was diagnosed in 313 patients (56.9%). ARF was mild in 215 cases (39.1%), moderate in 65 cases (11.8%) and severe in 33 cases (6%). Main causes leading to this complication were preeclampsia (66.5%) and acute hemorrhage (27.8%). Only two patients (0.4%) developed chronic renal failure and needed long-term dialysis. Patients who developed this complication had higher SOFA score (4.7 ± 3.5 vs. 3.2 ± 2.1; p < 0.001). Thirty-three patients (6%) died in the ICU. The rate of ICU mortality was significantly higher in patients with PRARF (9.3 vs. 1.7%; p < 0.001). CONCLUSIONS: PRARF is associated with higher mortality. Thus, appropriate monitoring of pregnancies is needed in order to prevent its onset by an early and prompt management of the underlying risk factors.

Predictive factors and prognostic value of candiduria in critically-ill patients with solid and hematological malignancies.

PURPOSE: To investigate the epidemiology of candiduria in critically-ill patients with solid/hematological malignancies and to assess its predictive factors and prognostic value. METHODS: All adult patients with confirmed solid/hematological malignancy admitted in the intensive care units (ICUs) for more than 48 h were retrospectively included. Urine cultures were sampled on admission and then whenever signs of sepsis were identified. Two groups were compared: (candiduria (+)) and (candiduria (-)). RESULTS: One-hundred-seventy-three patients were included. Solid cancer was the underlying oncological disease for 147 patients (85%) while 26 patients (15%) had hematological malignancies. Twenty-nine patients (16.8%) were diagnosed with candiduria, and 31 urinary samples grew Candida spp. Candida spp represented 55.8% of the total urinary isolates. Fourteen isolates (45.2%) of Candida albicans were identified. Among the 17 non-albicans isolates, Candida tropicalis was the most predominant (41.9%). Six patients (3.5%) had candidemia with no significant difference between candiduria(+) and candiduria(-) groups (respectively, 6.9% and 2.8%; p = 0.264). In multivariate analysis, previous exposure to quinolones (OR = 3.8, CI95% [1.4-8.3]; p = 0.008), mechanical ventilation (OR = 4.1, CI95% [1.1-14.7]; p = 0.034) and renal replacement therapy (OR = 3.5, 95%CI [1.2-9.7]; p = 0.017) were identified as independent factors predicting candiduria. Candiduria was associated with significantly higher ICU-mortality after adjusting for SAPSII score on admission (OR = 2.9 CI95% [1.3-6.8]; p = 0.009). CONCLUSION: Candiduria is common in cancer critically-ill patients. We reported an increased rate of non-albicans species, over albicans species. Patients with candiduria had higher ICU mortality, probably related to higher frailty and clinical severity.

Use of heptaminol hydrochloride for catecholamine weaning in septic shock.

We analyze in the current study the impact of heptaminol hydrochloride (Heptamyl) administration in patients with septic shock requiring adrenergic support on the duration of vasopressor infusion and on catecholamine delay weaning. In this prospective study were included 49 nonconsecutive patients with septic shock requiring vasopressor infusion and with stable hemodynamic parameters during more than 24 hours. All these patients were included in a random way to receive or not heptaminol hydrochloride. The primary end point was the effect of heptaminol hydrochloride administration on duration of weaning, defined as cessation of vasopressor support. There were 32 males (65%) and 17 females (35%). The mean age (± standard deviation) was 53.9 ± 22.2 years. Norepinephrine was the most commonly used vasopressor agent (73.4%). The comparison between two groups (with and without heptaminol hydrochloride) showed that two groups had the same epidemiologic, clinical, and biologic findings on intensive care unit admission. In our study, we found that the introduction of Heptamyl was associated with a quick decrease of dose of dopamine and norepinephrine in comparison with the Heptamyl-free group. By comparing the two groups, we found that the delay of catecholamine weaning was significantly faster for the dopamine (P = 0.008) and noradrenalin (P = 0.001) in the Heptamyl group. Finally, the intensive care unit mortality rate and the hospital mortality rate were significantly lower in the Heptamyl group. Our study shows a reduction in norepinephrine and dopamine weaning duration in septic patients enrolled in the heptaminol hydrochloride group.

[Use of catecholamines for shock. A continuous debate!]. / L'utilisation des Catecholamines dans les etats de choc. Le debat continue!

BACKGROUND: Hypotension and shocks are frequently observed in patients requiring admission in ICU. However, the optimal adrenergic support in shock is controversial. AIM: To perform a descriptive approach of the current use of catecholamine in a medico-surgical ICU in patients with schoks. METHODS: Our study is prospective over 3 month period. Were included all patients admitted in our ICU during the study period's. We compared the populations with and without catecholamine, we analysed the catecholamine selected in various clinical settings and we studied the impact of the use of catecholamine on the patient outcomes. RESULTS: During the study's period, 226 patients were hospitalized in our service and were the subject of this study. The median age (± SD) was of 47± 24 years. During their hospitalization in the ICU, 132 patients (58.4%) presented a shock. The cardiogenic shock and the hypovolemic shock were the most observed (37.8% and 35.6% respectively). Hundred thirty patients (57.5%) received catecholamines during their stay in ICU. Eighty four patients (64.6% of the patients having received catecholamines) had received dopamine. Sixty two patients (47.7% of the patients having received catecholamines) had received dobutamine, 63 patients (48.5%) had received epinephrine and 22 patients (16.9%) had received norepinephrine. The mean's period of catecholamines use was 5 ± 4 days. Among drugs proposed in order to manage patients with cardiogenic shock, dobutamine was chosen as the first choice agent in 62% of the cases. Among drugs proposed in order to manage patients with septic shock, Dopamine was chosen as the first choice agent in 85.7 % of the cases. In our study the patients of the class C or D in the Knauss classification are significantly predisposed to receive catecholamines during their ICU stay (OR: 5.3 ; IC 95% : 1.7 - 5.7).Moreover, the needing of catecholamine use is strongly associated with high mortality (OR: 16,8; IC 95% : 16.4 - 49.2). CONCLUSION: The choice of catecholamines is a matter of debate for critically ill patients. The use of catecholamines is a clinical marker of severity and provider of mortality.

Diffuse axonal injury in patients with head injuries: an epidemiologic and prognosis study of 124 cases.

BACKGROUND: Diffuse axonal injury (DAI) is usually associated to severe trauma. Recent imaging advances made its diagnosis easier. Its prognosis impact is not yet well established. The aim of this article is to describe the epidemiologic, clinical, and radiologic features of posttraumatic DAI and to study its prognosis impact on mortality and outcome according to Glasgow Outcome Scale. METHODS: This is a retrospective study over a 4-year period (2004-2007) of 124 patients admitted for head trauma. Demographic, clinical, biological, and radiologic findings were recorded at admission and during intensive care unit stay. RESULTS: Mean age (±standard deviation) was 28 years±15.8 years. Cranial computed tomography scan was sufficient enough to diagnose DAI in 31 patients. Magnetic resonance imaging was performed in 105 patients with a delay of 7.7 days±8.6 days. Most patients were classified as stage II (49.5%) or stage III (44.8%) according to Gentry's classification. In a multivariate analysis, factors associated with higher mortality were dysautonomia (p=0.018; odds ratio [OR]=4.17), hyperglycemia≥8 mmol/L (p=0.001; OR=3.84) on intensive care unit admission, and subdural hematoma (p=0.031; OR=3.99), whereas factors associated to poor outcome according to Glasgow Outcome Scale score were Glasgow Coma Scale score<8 (p=0.032, OR=3.55), secondary systemic injuries score≥3 (p=0.034, OR=2.83), hyperglycemia≥8 mmol/L (p=0.002, OR=5.55), and DAI count≥6 (p=0.035, OR=3.33). In patients with pure DAI, the absence of consciousness recovery was the unique independent factor of mortality (p<0.001, OR=116.4), whereas only transfusion need was an independent factor of poor outcome (p=0.017, OR=4.44). CONCLUSION: Dysautonomia, hyperglycemia, and subdural hematoma are the main factors associated to higher mortality when DAIs are diagnosed, whereas a DAI count≥6 is associated to poor outcome. Magnetic resonance imaging classification did not have a prognosis value even in patients with pure DAI.