Photo Credit: Pornpak Khunatorn

The following is a summary of “Risk factors, management, and outcomes in isolated parafalcine or tentorial subdural hematomas,” published in the April 2023 issue of Emergency Medicine by Juhasz, et al.

For a study, researchers sought to develop and validate a clinical decision rule for identifying patients with parafalcine or tentorial subdural hematomas (SDH) who are at low risk for complications and thus may not require hospitalization. 

Adult patients with parafalcine or tentorial SDHs had their medical records retrospectively reviewed at many centers. The main result was a major injury, which required neurosurgery, being transferred to another facility, or being fatal. First, a multivariable logistic regression was carried out to determine factors independently linked to the result in the derivation cohort. Then, without disclosing the variables’ identification, these variables were validated on a different cohort from a different institution.

The derivation cohort included 134 patients with parafalcine or tentorial SDHs, with a mean age of 63 ± 19 years and 82 (61%) males. Of these, 71 (53%) had significant injuries. A multivariable logistic regression identified three variables that were independently associated with significant injury: age over 60 with an adjusted odds ratio (aOR) of 3.46 (95% CI 1.24, 9.62), initial Glasgow Coma Scale (GCS) score below 15 with an aOR of 7.92 (95% CI 2.78, 22.5), and additional traumatic brain injuries (TBIs) on computerized tomography (CT) with an aOR of 5.97 (95% CI 2.48, 14.4). The sensitivity of these three variables was 100% (95% CI 96, 100%) with a specificity of 19% (95% CI 10, 31%) in the derivation cohort. The validation cohort (n = 83) had a mean age of 62 ± 22 years with 50 (60%) males. The three variables had a sensitivity of 100% (95% CI 92, 100%) and a specificity of 15% (95% CI 6.2, 28%) in this cohort. All 39 (100%, 95% CI 93, 100%) patients from both cohorts who underwent neurosurgery had additional TBI findings on their CT scan.

The study concluded that patients with parafalcine or tentorial SDHs under 60 years old had initial GCS scores of 15, and no additional TBIs on CT were at low risk and may not require hospitalization. Moreover, patients with isolated parafalcine or tentorial SDHs are unlikely to undergo neurosurgery. The study recommended perspective, and external validation with a larger sample size.

Source: sciencedirect.com/science/article/abs/pii/S0735675723000177