B. N. Cragun1, M. R. Noorbakhsh1, F. Hite Philp1, M. F. Ditillo1, E. R. Suydam1, A. D. Murdock1 1Allegheny General Hospital,Pittsburgh, PA, USA
Introduction:
Isolated parafalcine subdural hematoma (SDH) represents a common cause of trauma admission. Although no distinction is made with regard to location or type of bleed in the guidelines for management of SDH, parafalcine SDH may represent a distinct clinical entity with differing clinical behavior. We hypothesize that isolated parafalcine bleeds, as compared to other SDH, were unlikely to require neurosurgical intervention and do not benefit from critical care monitoring.
Methods:
Trauma registry data was used to identify patients presenting to a single level I trauma center with isolated intracranial hemorrhage (ICH) from February 2016 to April 2017. Isolated ICH was defined as abbreviated injury score (AIS) of ≥3 for head and <3 for any other body location, and we further identified patients with isolated SDH. Data reviewed included: neurosurgical interventions, radiographic worsening of the bleed, mortality, level of care, GCS on admission and discharge, disposition, and demographics.
Results:
We identified 164 isolated SDH, of which 45 had isolated parafalcine ICH. Antiplatelet or anticoagulant use was equally prevalent in both groups (49% of parafalcine bleeds vs 54% in other SDH). Average age was 68 ± 21. Parafalcine SDH had a similar rate of radiographic progression (8.9% vs 11.8%), but none had neurological deterioration and none required neurosurgical intervention. Mortality was significantly lower in parafalcine SDH as compared to other SDH (0% vs 10.1%, p=0.04). Mortality, length of stay (LOS), neurological deterioration, radiographic worsening, and need for neurosurgical intervention are compared between the two groups as summarized in Table 1.
Conclusion:
Our data showed no mortality, no clinical worsening, and no neurosurgical intervention in parafalcine SDH, suggesting that parafalcine bleeds represent a benign entity as compared to other SDH. While several patients with parafalcine bleeds had radiographic progression, this did not translate to neurological deterioration or need for intervention. This data suggests that admission to an ICU, as well as interval imaging, are unlikely to be helpful in the setting of isolated parafalcine SDH. Collectively, these data begin to build evidence for our consideration of a change in practice in the management of parafalcine SDH, as they appear to be a distinct clinical entity from other types of SDH in our trauma population.
