Risk factors, management, and outcomes in isolated parafalcine or tentorial subdural hematomas

被引:3
作者
Juhasz, Kristin A. [1 ]
Iszkula, Erik R. [1 ]
English, Gregory R. [2 ]
Desiderio, Daniel B. [1 ]
Estrada, Carmen Y. [3 ]
Leshikar, David E. [4 ]
Pfeiffer, Benjamin T. [1 ]
Roesel, Emily H. [1 ]
Wagle, Ashley E. [1 ]
Holmes Jr, James F. [5 ]
机构
[1] UPMC Hamot, Dept Emergency Med, 201 State St, Erie, PA 16550 USA
[2] UPMC Hamot, Dept Surg, 300 State St,Suite 401, Erie, PA 16507 USA
[3] Univ Calif Davis, Sch Med, 4610 X St, Sacramento, CA 95817 USA
[4] Univ Calif Davis, Dept Surg, 2335 Stockton Blvd, Sacramento, CA 95817 USA
[5] Univ Calif Davis, Dept Emergency Med, 4150 V St Patient Support Serv Bldg PSSB,Suite 210, Sacramento, CA 95817 USA
关键词
Parafalcine; Tentorial; Subdural; Trauma; Traumatic brain injuries; TRAUMATIC BRAIN-INJURY; NEW-ORLEANS CRITERIA; CT HEAD RULE; INTRACRANIAL HEMORRHAGE; UNITED-STATES; ANTICOAGULANT; DEATHS;
D O I
10.1016/j.ajem.2023.01.014
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Introduction: Indications for hospitalization in patients with parafalcine or tentorial subdural hematomas (SDH) remain unclear. This study derived and validated a clinical decision rule to identify patients at low risk for com-plications such that hospitalization can be avoided.Methods: A multicenter retrospective medical record review of adult patients with parafalcine or tentorial SDHs was completed. The primary outcome was significant injury, defined as injury that led to neurosurgery, discharge to another facility, or death. A multivariable logistic regression was performed to identify variables indepen-dently associated with the outcome in the derivation cohort. These variables were then validated on a separate cohort from a different institution abstracted without knowledge of the identified variables.Results: In the derivation cohort, 134 patients with parafalcine/tentorial SDHs were identified. The mean age was 63 +/- 19 years with 82 (61%) male. Seventy-one (53%) had significant injuries. Variables independently associ-ated with significant injury included: age over 60, adjusted odds ratio (aOR) 3.46 (95% CI 1.24, 9.62), initial Glas-gow Coma Scale score below 15, aOR =7.92 (95% CI 2.78, 22.5), and additional traumatic brain injuries (TBIs) on computerized tomography (CT), aOR =5.97 (95% CI 2.48, 14.4). These three variables had a sensitivity of 71/71 (100%, 95% CI 96,100%) and specificity of 12/63 (19%, 95% CI 10, 31%). The validation cohort (n = 83) had a mean age of 62 +/- 22 years with 50 (60%) male. The three variables had a sensitivity of 36/36 (100%, 95% CI 92, 100%) and specificity of 7/47 (15%, 95% CI 6.2, 28%). All 39 (100%, 95% CI 93, 100%) patients from both cohorts who un-derwent neurosurgery had additional TBI findings on their CT scan.Conclusions: Patients with parafalcine/tentorial SDHs who are under 60 years with initial GCS scores of 15 and no addition TBIs on CT are at low risk and may not need hospitalization. Furthermore, patients with isolated parafalcine/tentorial SDHs are unlikely to undergo neurosurgery. Prospective, external validation with a larger sample size is now recommended. Study type: Retrospective Cohort Study. (c) 2023 Elsevier Inc. All rights reserved.
引用
收藏
页码:135 / 140
页数:6
相关论文
共 21 条
[1]  
[Anonymous], 2016, Abbreviated Injury Scale (c) 2005 Update 2008
[2]   Understanding the Value of Repeat Head CT in Elderly Trauma Patients on Anticoagulant or Antiplatelet Therapy [J].
Battle, Bennett ;
Sexton, Kevin W. ;
Fitzgerald, Ryan T. .
JOURNAL OF THE AMERICAN COLLEGE OF RADIOLOGY, 2018, 15 (02) :319-321
[3]  
Coronado Victor G., 2011, Morbidity and Mortality Weekly Report, V60, P1
[4]   Traumatic Parafalcine Subdural Hematoma: A Clinically Benign Finding [J].
Cragun, Benjamin N. ;
Noorbakhsh, Matthew R. ;
Philp, Frances Hite ;
Suydam, Erin R. ;
Ditillo, Michael F. ;
Philp, Allan S. ;
Murdock, Alan D. .
JOURNAL OF SURGICAL RESEARCH, 2020, 249 :99-103
[5]   Isolated intracranial hemorrhage in elderly patients with pre-injury anticoagulation: is full trauma team activation necessary? [J].
Diaz, Joseph ;
Rooney, Alexandra ;
Calvo, Richard Y. ;
Benham, Derek A. ;
Carr, Matthew ;
Badiee, Jayraan ;
Sise, C. Beth ;
Sise, Michael J. ;
Bansal, Vishal ;
Martin, Matthew J. .
JOURNAL OF SURGICAL RESEARCH, 2021, 268 :491-497
[6]   Chart reviews in emergency medicine research: Where are the methods? [J].
Gilbert, EH ;
Lowenstein, SR ;
KoziolMcLain, J ;
Barta, DC ;
Steiner, J .
ANNALS OF EMERGENCY MEDICINE, 1996, 27 (03) :305-308
[7]   Epidemiology of blunt head injury victims undergoing ED cranial computed tomographic scanning [J].
Holmes, JF ;
Hendey, GW ;
Oman, JA ;
Norton, VC ;
Lazarenko, G ;
Ross, SE ;
Hoffman, JR ;
Mower, WR .
AMERICAN JOURNAL OF EMERGENCY MEDICINE, 2006, 24 (02) :167-173
[8]   Management and Outcomes of Isolated Tentorial and Parafalcine "Smear'' Subdural Hematomas at a Level-1 Trauma Center: Necessity of High Acuity Care [J].
Howard, Brian M. ;
Rindler, Rima S. ;
Holland, Christopher M. ;
Pradilla, Gustavo ;
Ahmad, Faiz U. .
JOURNAL OF NEUROTRAUMA, 2017, 34 (01) :128-136
[9]   Improving Hospital Quality and Costs in Nonoperative Traumatic Brain Injury The Role of Acute Care Surgeons [J].
Joseph, Bellal ;
Pandit, Viraj ;
Haider, Ansab A. ;
Kulvatunyou, Narong ;
Zangbar, Bardiya ;
Tang, Andrew ;
Aziz, Hassan ;
Vercruysse, Gary ;
O'Keeffe, Terence ;
Freise, Randall S. ;
Rhee, Peter .
JAMA SURGERY, 2015, 150 (09) :866-872
[10]   Multicenter assessment of the Brain Injury Guidelines and a proposal of guideline modifications [J].
Khan, Abid D. ;
Elseth, Anna J. ;
Brosius, Jacqueline A. ;
Moskowitz, Eliza ;
Liebscher, Sean C. ;
Anstadt, Michael J. ;
Dunn, Julie A. ;
McVicker, John H. ;
Schroeppel, Thomas ;
Gonzalez, Richard P. .
TRAUMA SURGERY & ACUTE CARE OPEN, 2020, 5 (01)