title: Small subdural hemorrhages: is routine intensive care unit admission necessary?
abstract: With advancing technology, the sensitivity of computed tomography (CT) for the detection of subdural hematoma (SDH) continues to improve. In some cases, the finding is limited to one or 2 images of the CT examination. At our institution, all patients with an SDH require intensive care unit (ICU) admission, regardless of size. In this report, we tested the hypothesis that patients with a small traumatic SDH on their presenting CT examination do not require the intensive monitoring offered in the ICU and can instead be managed on a hospital unit with a lower level of monitoring. This is a retrospective study of patients evaluated and treated at a level I trauma center for acute traumatic intracranial hemorrhage between 2011 and 2014. The clinical and imaging profile of 87 patients with traumatic SDH were studied. Patients with small isolated traumatic subdural hemorrhage (tSDH) (<10 cm(3) blood volume) spent less time in the ICU, demonstrated neurologic and medical stability during hospitalization, and did not require any neurosurgical intervention. It is our recommendation that patients with isolated tSDH (<10 cm(3)) do not require ICU monitoring. Patients with small tSDH and additional intracranial hemorrhages overall show low rates of medical decline (4%) and neurologic decline (4%) but may still benefit from ICU observation. Patients with tSDH greater than 10 cm(3) overall demonstrated poor clinical courses and outcome and would benefit ICU monitoring.
authors.affiliation: Department of Radiology, The George Washington University, First Floor, 900 23rd St NW, Washington, DC 20037.
authors.forename: Paul
authors.initials: P
authors.lastname: Albertine
authors.affiliation: Department of Radiology, The George Washington University, First Floor, 900 23rd St NW, Washington, DC 20037. Electronic address: sborofsky@gwu.edu.
authors.forename: Samuel
authors.initials: S
authors.lastname: Borofsky
authors.affiliation: Department of Radiology, The George Washington University, First Floor, 900 23rd St NW, Washington, DC 20037.
authors.forename: Derek
authors.initials: D
authors.lastname: Brown
authors.affiliation: Department of Radiology, The George Washington University, First Floor, 900 23rd St NW, Washington, DC 20037.
authors.forename: Smita
authors.initials: S
authors.lastname: Patel
authors.affiliation: Department of Radiology, The George Washington University, First Floor, 900 23rd St NW, Washington, DC 20037.
authors.forename: Woojin
authors.initials: W
authors.lastname: Lee
authors.affiliation: Department of Radiology, The George Washington University, First Floor, 900 23rd St NW, Washington, DC 20037.
authors.forename: Anthony
authors.initials: A
authors.lastname: Caputy
authors.affiliation: Department of Radiology, The George Washington University, First Floor, 900 23rd St NW, Washington, DC 20037.
authors.forename: M Reza
authors.initials: MR
authors.lastname: Taheri
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D023261:Glasgow Outcome Scale; D006408:Hematoma, Subdural / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D007362:Intensive Care Units / Q000592:standards* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000592:standards* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers / Q000592:standards / Q000706:statistics & numerical data; D015599:Trauma Severity Indices; D055815:Young Adult