Introduction: Patients with high impact trauma can sustain Diffuse Axonal Injury (DAI) and may have poor prognosis. Blood pressure variability (BPV) has been shown to be associated with poor prognosis in TBI patients but it has not been studied among patients with DAI. Our study investigated whether 24-hour BPV after injury and other clinical factors would be associated with patients’ outcomes. Methods: This is a retrospective study involving all adult patients who presented to a Regional Quaternary Trauma Center between 01/01/2017-12/31/2021. Patients who were radiologically classified as having DAI and received MRI were eligible, as presence of DAI on Magnetic Resonance Imaging (MRI) is also associated with poor outcome. Outcomes were hospital dispositions (ranking from Being discharged home, Rehabilitation facility, Dead) and Glasgow Coma Scale on hospital day 5 (HD5GCS ranking from 3-8, 9-12, 13-14, 15), which also correlated with patients’ 90-day neurocognitive function. We performed ordinal logistic regression to measure association between clinical factors and outcome. Results: We identified and analyzed 154 patients. Mean age was 49 (± 20) years and 114 (74%) were male. Median [IQR] GCS at admission and 24-hour, hospital day 5 were 5 [3-11], 5 [7-10], 8 [6-11], respectively. Most common lesion location was Corpus (89/154, 58%), brain stem (68/154, 44%). Seventy-one (46%) patients had highest Adam score of 3. Ordinal regression showed that BPV components were not associated with DAI patients’ outcome. However, increased age (Coeff. -0.04, OR 0.95, 95%CI 0.92-0.99), Brainstem lesion (Coeff -3.1, OR 0.04, 95%CI 0.001-0.36), requiring anti-hypertensive infusion (Ceff -1.9, OR 0.15, 95%CI 0.03-0.891), blood transfusion (coeff -2.4, OR 0.08, 95%CI 0.01-0.51 were associated with higher mortality, while only high GCS at 24 hours was associated with high HD5GCS (Coeff -01.6, OR 0.85, 95%CI 0.74-0.99) Conclusions: Blood pressure variability was not associated with outcome among patients with DAI. However, increased age, having brainstem lesion, requiring anti-hypertensive infusion and blood products were associated with poor outcome, while high GCS on 24 hour after admission was associated with high GCS on hospital day 5.