Hospital costs, incidence, and inhospital mortality rates of traumatic subdural hematoma in the United States

Kalanithi, Paul; Schubert, Ryan; Lad, Shivanand P.; Harris, Odette A.; Boakye, Maxwell

doi:10.3171/2011.6.jns101989

Cited by 46 publications

(41 citation statements)

References 28 publications

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“…This is similar to the 15% operatively treated traumatic SDH mortality rate, but substantially higher than the 7% operatively treated nontraumatic SDH mortality rate from NIS data. 4,10 The most likely explanation for this more than 2-fold difference is that NIS only captures inpatient mortality, whereas NSQIP captures all deaths within 30 days, including at home, in rehabilitation facilities, and in hospices. 1 In addition, the distinction between a traumatic and a nontraumatic SDH based on ICD-9 coding appears dubious, as truly nontraumatic SDH is a rare condition.…”

Section: Mortality Ratementioning

confidence: 99%

“…4,10 However, nontraumatic SDH in this context does not represent true spontaneous hemorrhage, but rather an SDH without a documented known injury. Hence, despite the difference in coding, these patients were considered together in this study.…”

Section: Patient Populationmentioning

confidence: 99%

“…These groups have found a mortality rate of 15% for traumatic SDH treated operatively, 7% for nontraumatic SDH treated operatively, and 12% for SDH overall. 4,6,10 Although these above-noted NIS studies have clarified the modern risk of death associated with surgical evacuation of SDH in the US, the general health morbidity associated with surgical treatment of SDH has not been examined. However, the NIS database, while a valuable resource, only captures complications that occur during inpatient stays.…”

mentioning

confidence: 99%

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Patient factors associated with 30-day morbidity, mortality, and length of stay after surgery for subdural hematoma: a study of the American College of Surgeons National Surgical Quality Improvement Program

Lukasiewicz

Grant

Basques

et al. 2016

JNS

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Subdural hematoma (SDH) is a common condition confronting neurosurgeons, resulting in more than 90,000 hospitalizations annually. 6 Morbidity, mortality, and length of stay (LOS) in patients treated with surgical evacuation of SDH are not well described, and the patient characteristics associated with adverse outcomes are not clearly established.Positive outcomes following surgery for SDH have been demonstrated, particularly in young patients and in patients treated within 4 hours of injury. 9,18,19 However, this population has a known significant risk of death. Historically, death after surgical evacuation of SDH has been reported in the range of 30%-60%. 5,12,20,22 More recently, 3 groups have investigated the mortality risk of SDH using abbreviatioNs ACS = American College of Surgeons; ASA = American Society of Anesthesiologists; BMI = body mass index; CHF = congestive heart failure; CPT = Current Procedural Terminology; DVT = deep venous thrombosis; ICD-9 = International Classification of Diseases, Ninth Revision; LOS = length of stay; MI = myocardial infarction; NIS = National Inpatient Sample; NSQIP = National Surgical Quality Improvement Project; OR = operating room; PE = pulmonary embolism; RR = relative risk; SDH = subdural hematoma. results A total of 746 surgical procedures performed for SDH were identified and analyzed. Patients undergoing this procedure were 64% male with an average age (± SD) of 70.9 ± 14.1 years. The most common individual adverse events were death (17%) and intubation for more than 48 hours (19%). In total, 34% experienced a serious adverse event other than death, 8% of patients returned to the operating room (OR), and the average hospital LOS was 9.8 ± 9.9 days. In multivariate analysis, reduced mortality was associated with age less than 60 years (relative risk coNclusioNs Adverse outcomes are common after surgery for SDH. In this study, 18% of the patients died within 30 days of surgery. Factors associated with adverse outcomes were identified. Patients and families should be counseled about the serious risks of morbidity and death associated with acute traumatic SDH requiring surgery.[http://thejns.org/doi/abs/10.3171/2015.2.JNS142721

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Section: Mortality Ratementioning

confidence: 99%

Section: Patient Populationmentioning

confidence: 99%

mentioning

confidence: 99%

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Patient factors associated with 30-day morbidity, mortality, and length of stay after surgery for subdural hematoma: a study of the American College of Surgeons National Surgical Quality Improvement Program

Lukasiewicz

Grant

Basques

et al. 2016

JNS

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“…18 Nevertheless, Bartels et al reported that a large majority (69%) of cases of ISH included in their review required operative intervention (e.g., craniotomy, burr holes), 6 contrary to other forms of subdural hematoma. 19 The clinical manifestations of ISH depend on the specific location and size of the hematoma and the progression of the neurological symptoms that it produces. 13 In our patient, the clinical picture was assumed to be PDPH because of the temporal relationship between the appearance of the patient's symptoms and the onset of a positiondependent headache after accidental dural puncture.…”

Section: Discussionmentioning

confidence: 99%

Bilateral interhemispheric subdural hematoma after inadvertent lumbar puncture in a parturient

Liang

Pagel

2012

Can J Anesth/J Can Anesth

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Purpose Interhemispheric subdural hematomas (ISH) are rare in adults and occur most often after cranial trauma. We describe a parturient who developed bilateral acute ISH after inadvertent dural puncture associated with placement of an epidural catheter for labour analgesia. We discuss the features, pathophysiology, and management of this type of subdural hematoma. Clinical features A 38-yr-old woman requested epidural analgesia for relief of labour pain. An inadvertent dural puncture occurred during placement of a 17G Tuohy needle. After labour and delivery, the patient developed symptoms of a postdural puncture headache, which responded only partially to an epidural blood patch. The patient's headache subsequently became less positiondependent and was associated with episodes of sharp pain radiating down her legs and paresthesias on the left side of her body. A computed tomography (CT) scan showed right frontal and left parietal acute ISH without an intracranial mass effect. The patient was monitored in the intensive care unit and treated conservatively because of the relatively small size of the ISH and the absence of progressive neurological deficits on serial examinations. Daily CT scans showed gradual decreases in the size of the ISH concomitant with improvement of the headache. Conclusions Rupture of bridging veins between the cerebral cortex and the superior sagittal sinus is the usual mechanism by which ISH occur. Nearly one-quarter of patients with ISH do not survive, although those with smaller hematomas have a better outcome. If the hematoma is \ 1 cm in thickness, a conservative approach to ISH is recommended in the absence of mental status changes, seizure activity, or focal deficits, but with larger ISH or evidence of progressive neurological deterioration, surgical evacuation is most often required to prevent mortality. RésuméObjectif Les he´matomes sous-duraux inter-he´misphe´riques (ISH) sont rares chez l'adulte et surviennent le plus souvent apre`s un traumatisme craˆnien. Nous de´crivons le cas d'une parturiente qui a pre´sente´un he´matome sous-dural aigu bilate´ral apre`s ponction durale accidentelle en rapport avec la mise en place d'un cathe´ter pe´ridural pour analge´sie au cours du travail. Nous discutons les caracte´ristiques, la physiopathologie et la prise en charge de ce type d'he´matome sous-dural. Caractéristiques cliniques Une femme aˆge´e de 38 ans a demande´a`be´ne´ficier d'une analge´sie pe´ridurale pendant le travail. Il y a eu une ponction accidentelle de la dure-me`re pendant la mise en place d'une aiguille de Tuohy 17G. Apre`s le travail et l'accouchement, la patiente a pre´sente´des symptômes de ce´phale´e post ponction dure-me´rienne qui n'ont re´pondu que partiellement a`un colmatage sanguin (blood patch) pe´ridural. La ce´phale´e de la patiente est devenue ensuite moins lie´e à la position, mais elle a e´te´associe´e à des e´pisodes de douleurs aigues

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“…62 A 2011 study on mortality associated with traumatic SDH indicated a mortality rate of between 10% and 20%. 63 While clearly the decline in mortality cannot be attributed to improved imaging alone, it certainly plays a role. Within a few years of the introduction of CT, pneumoencephalography was extinct and the use of angiography decreased.…”

mentioning

confidence: 99%

Neuroradiology Back to the Future: Brain Imaging

Hoeffner¹,

Mukherji²,

Srinivasan³

et al. 2011

AJNR Am J Neuroradiol

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Hospital costs, incidence, and inhospital mortality rates of traumatic subdural hematoma in the United States

Abstract: Nationally, frequency and cost of traumatic SDH cases are increasing rapidly.

Cited by 46 publications

References 28 publications

Patient factors associated with 30-day morbidity, mortality, and length of stay after surgery for subdural hematoma: a study of the American College of Surgeons National Surgical Quality Improvement Program

Patient factors associated with 30-day morbidity, mortality, and length of stay after surgery for subdural hematoma: a study of the American College of Surgeons National Surgical Quality Improvement Program

Bilateral interhemispheric subdural hematoma after inadvertent lumbar puncture in a parturient

Neuroradiology Back to the Future: Brain Imaging

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