Title: The impact of axial injury, extra-axial injury, and combined injury on functional status in traumatic brain injury (tbi) Authors

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Title: The impact of axial injury, extra-axial injury, and combined injury on functional status in traumatic brain injury (TBI)

Authors: Nhung Quach M.D., Reza Ehsanian M.D. Ph.D., Samantha Sechrist, Saranya P. Balakrishnan M.D. Thao Duong M.D., James Crew M.D., & Linda Isaac PhD.


  1. Describe functional status by using the disability rating scales (DRS) and functional independence measure (FIM) scores in axial lesions, extra-axial lesions and combined lesion groups

  2. Investigate the affecting differences between three types of injury in functional status.

Design: Prospective longitudinal study. Head computed tomography (CT) scans were taken within 7 days from date of injury were evaluated. The population was divided into three groups based on the radiographic presentation of the lesions: extra-axial (epidural hematoma, sub-epidural hematoma, and subarachnoid hemorrhage), axial (punctate/petechial hemorrhages, intra-ventricular hemorrhage, cortical parenchymal lesions, non-cortical parenchymal lesions), and combined (involving both axial and extra-axial lesions). DRS and FIM was used to evaluate function at 3 time points (admission, discharge, and one-year follow-up).
Setting: Patients from the Northern California Traumatic Brain Injury Model System of Care (TBIMS) were admitted to the rehabilitation department between 1989-2011 and followed up to 1 year post injury.

Participants: There were 450 moderate to severe TBI patients. Patients lost to follow-up, without head CT scan results, or without intracranial lesions were excluded from the study.

Interventions: None

Main Outcome Measures: head CT, DRS, and FIM

Level of Evidence: 2b

Results: No statistical differences were found in functional status between the axial and extra-axial groups, except for the FIM follow-up after 1 year, which unexpectedly showed the axial group having greater functional recovery (p=.046). The combined lesion group showed statistically significant greater negative impact on functional status than the other groups across all three time points.


Combined lesions negatively affect functional status more than axial lesions or extra-axial lesions. The effect of combined injuries will increase the awareness of healthcare providers and likely inform the patient care and patient likelihood of recovery.
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