Management and Outcomes of Isolated Tentorial and Parafalcine "Smear" Subdural Hematomas at a Level-1 Trauma Center: Necessity of High Acuity Care.

Abstract

Data suggest that patients who present to trauma centers with mild traumatic brain injury (TBI) are admitted to an excessively high level of care and undergo myriad, unnecessary repeat radiographic and laboratory tests that do not affect outcome. Surprisingly, a paucity of data exists regarding the management of isolated, traumatic, parafalcine, or tentorial acute subdural hematoma (aSDH). Therefore, a retrospective, cohort study was completed to analyze factors associated with outcomes in patients who present to a high-volume, urban, level 1 trauma center with isolated parafalcine or tentorial aSDH after closed head injury. Out of 3097 patients admitted with TBI over the study period, 65 met inclusion criteria. More than 90% of patients were admitted to the intensive care unit (ICU), irrespective of Glasgow Coma Scale (GCS) score at presentation or the presence of systemic injury. Factors determined to be statistically associated with increased ICU and total length of stay were GCS ≤ 12 on presentation and presence of systemic injury. Depressed GCS, systemic injury, and being elderly were associated with poor discharge disposition; whereas being systemically injured, female, or elderly were associated with poor functional status at discharge. Although 94% of admitted patients underwent at least one repeat head computed tomography (CT) scan while hospitalized, not a single aSDH enlarged, including four patients on antiplatelet agents, anticoagulants, or both. Based on these data, young patients who present with GCS 13-15 without systemic injury following blunt trauma with an associated isolated parafalcine and tentorial aSDH may be safely admitted to a standard medical/surgical floor for observation.