Objective: Acute traumatic subdural hematomas (TSDH) readmission rate is high (27.8%) with an increase in morbidity and cost for the elderly. This study identifies risk factors affecting readmission rates for these patients and presents strategies to reduce it. Methods: A retrospective analysis was conducted including patients with TSDH admitted to our Community Hospital and followed subsequently for two years regarding readmission within 6 months of initial discharge. The following factors were compared for patients readmitted versus not readmitted: patient age, sex, number of comorbidities, anticoagulation status, surgical intervention, ICU length of stay, injury severity score, and discharge disposition. Results: A total of 167 patients were included in the study. Overall, 75 patients (44.9%) were readmitted within 6 months. Readmitted patients had an overall higher mean age (74.1 vs. 65.4, p = 0.001). Readmission with recurrent subdural hematoma was diagnosed in 32.2% of readmitted patients vs. 67.8% (p < 0.0005) with readmission for other medical complications. 80.0% of readmitted patients had more than four comorbid conditions (p < 0.0001). Conclusion: This study identifies risk factors that affect readmission rates for patients with TSDH and establishes strategies that may help to decrease readmission. Highlights:

While transcutaneous continuous monitoring of partial pressure of oxygen (TcPO2) is a proven valuable diagnostic tool in intensive care of sick neonates, its use in older children is less well defined. The purpose of this study is to establish the accuracy and reliability of TcPO2 as a reflection of arterial partial pressure of oxygen (PaO2) in critically ill pediatric patients. Twenty-six children, age ranging from 4 days to 13 years, were studied. The main diagnostic categories were cardiac 54 per cent, respiratory 27 per cent, gastrointestinal 15 per cent, and neurologic 4 per cent. Forty three estimations of PaO2 (by radial arterial sampling) and TcPO2 (by cutaneous monitor) were obtained simultaneously. Their correlation coefficient, regression equation, and confidence limits were calculated by standard statistical methods with the aid of a microcomputer. Our data show that the high degree of correlation between TcPO2 and PaO2 is highly significant (r = 0.90, p less than 0.001) for the full range of PaO2 between 0 to 200 mm Hg. At the lower range of PaO2 (0-79 mm Hg), the degree of correlation (r = 0.91, p less than 0.001) is better than that (r = 0.77, p less than 0.001) at the higher range (80-200 mm Hg), although the difference between the two correlation coefficients is not significant (p greater than 0.05). It is important to note that TcPO2 consistently underestimates the PaO2 and the 95% confidence limits are rather wide. We conclude that TcPO2 is a reasonably accurate reflection of PaO2 in critically ill pediatric patients. Its main advantage is in predicting and showing trends in tissue oxygenation by noninvasive means. However, when critical assessment of the degree of hypoxemia is required, TcPO2 is no substitute for PaO2.

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