This study provides the first US national data regarding frequency, cost, and mortality rate of traumatic subdural hematoma (SDH), and identifies demographic factors affecting morbidity and death in patients with traumatic SDH undergoing surgical drainage.
A retrospective analysis was conducted by querying the Nationwide Inpatient Sample, the largest all-payer database of nonfederal community hospitals. All cases of traumatic SDH were identified using ICD-9 codes. The study consisted of 2 parts: 1) trends data, which were abstracted from the years 1993–2006, and 2) univariate analysis and multivariate logistic regression of demographic variables on inhospital complications and deaths for the years 1993–2002.
Admissions for traumatic SDH increased 154% from 17,328 in 1993 to 43,996 in 2006. Inhospital deaths decreased from 16.4% to 11.6% for traumatic SDH. Average costs increased 67% to $47,315 per admission. For the multivariate regression analysis, between 1993 and 2002, 67,864 patients with traumatic SDH underwent operative treatment. The inhospital mortality rate was 14.9% for traumatic SDH drainage, with an 18% inhospital complication rate. Factors affecting inhospital deaths included presence of coma (OR = 2.45) and more than 2 comorbidities (OR = 1.60). Increased age did not worsen the inhospital mortality rate.
Nationally, frequency and cost of traumatic SDH cases are increasing rapidly.
Abbreviations used in this paper: GCS = Glasgow Coma Scale; LOS = length of stay; NIS = Nationwide Inpatient Sample; SDH = subdural hematoma.
* Drs. Kalanithi and Schubert contributed equally to this study.Address correspondence to: Paul Kalanithi, M.D., Department of Neurosurgery, Lane Building, Stanford University Medical Center, 300 Pasteur Drive, Palo Alto, California 94305. email: email@example.com.Please include this information when citing this paper: published online August 5, 2011; DOI: 10.3171/2011.6.JNS101989.
CruzJMGMinojaGOkuchiK: Improving clinical outcomes from acute subdural hematomas with the emergency preoperative administration of high doses of mannitol: a randomized trial. Neurosurgery49:864–8712001
CruzJMG, MinojaG, OkuchiK: Improving clinical outcomes from acute subdural hematomas with the emergency preoperative administration of high doses of mannitol: a randomized trial. 49:864–871, 2001)| false
Healthcare Cost and Utilization Project (HCUP) Agency for Healthcare Research and Quality: Overview of the Nationwide Inpatient Sample (NIS)(www.hcup-us.ahrq.gov/nisoverview.jsp) [Accessed June 24 2011]
Healthcare Cost and Utilization Project (HCUP) Agency for Healthcare Research and Quality: (www.hcup-us.ahrq.gov/nisoverview.jsp) [Accessed June 24, 2011])| false
ServadeiFNasiMTCremoniniAMGiulianiGCenniPNanniA: Importance of a reliable admission Glasgow Coma Scale score for determining the need for evacuation of posttraumatic subdural hematomas: a prospective study of 65 patients. J Trauma44:868–8731998
ServadeiF, NasiMT, CremoniniAM, GiulianiG, CenniP, NanniA: Importance of a reliable admission Glasgow Coma Scale score for determining the need for evacuation of posttraumatic subdural hematomas: a prospective study of 65 patients. 44:868–873, 1998)| false