Factors associated with the progression of conservatively managed acute traumatic subdural hemorrhage

• Published in: Journal of critical care Vol. 48; pp. 243 - 250
• Main Authors: Powers, Andrew Y., Pinto, Mauricio B., Aldridge, Ashley M., Tang, Oliver Y., Chen, Jia-Shu, Berube, Rebecca L., Doberstein, Cody, Fox, Jordan M., Carnevale, Joseph A., Asaad, Wael F.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-12-2018; Elsevier Limited
• Subjects: Age; Anticoagulants; Blood platelets; Blood pressure; Critical Care; Hemorrhage; Hemorrhage, Intracranial; Hemorrhage, Subdural; Hypothesis testing; Injuries, Head; Medical imaging; Mortality; Subdural Hematoma; Trauma; Traumatic Brain Injury; Variables; BAC; ISS; Injuries, Head; Hemorrhage, Subdural; Subdural Hematoma; CT; Traumatic Brain Injury; Hemorrhage, Intracranial; AICc; GCS; SDH; Critical Care; TBI
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2018.09.014

Traumatic subdural hemorrhage (SDH) is associated with high mortality, yet many patients are not managed surgically. We sought to understand what factors might be associated with SDH enlargement to contribute to the triage of these conservatively managed patients.
A consecutive series of 117 patients admitted to our institution's level 1 trauma center for SDH between January 1, 2010 and December 31, 2010 were evaluated. Volumetric measurement of SDHs was performed on initial and follow-up head computed tomography (CT) scans with recording of initial midline shift and classification by location. Multimodel analysis quantified associations with change in SDH volume.
Systolic blood pressure, presence of subarachnoid hemorrhage, and initial SDH volume demonstrated positive associations with change in SDH volume, while initial midline shift and transfusion of platelets demonstrated negative associations. Initial convexity SDH volume demonstrated positive association with change in convexity SDH volume, while initial midline shift and transfusion of platelets demonstrated negative associations. Anticoagulant/antiplatelet use demonstrated positive association with change in tentorial SDH volume, while time between CT scans demonstrated negative association.
Platelet transfusion, anticoagulation, and hypertension have significant associations with expansion in non-surgical cases of SDH. Monitoring these factors may assist triaging these patients.
•Midline shift may lead to subdural hemorrhage tamponade, preventing expansion.•Larger subdural hemorrhages undergo greater expansion.•Platelet transfusion may counteract hemorrhage expansion.