National trend in prevalence, cost, and discharge disposition after subdural hematoma from 1998-2007

Objectives: Subdural hematoma is a common type of intracranial hemorrhage, particularly among the elderly, yet, despite the aging U. S. population, little has been published in the last 10 yrs. This study aimed to determine national trends in prevalence, discharge disposition, length of stay, and cost of subdural hematoma over time. Design: Retrospective cohort study. Setting: Adult patients hospitalized in the United States between 1998 and 2007 identified in the Nationwide Inpatient Sample. Participants: Seven hundred twenty thousand, two hundred ninety-seven adult patients hospitalized in subdural hematoma. Interventions: None. Measurements and Main Results: Discharge disposition, hospital length of stay, and national cost (adjusted to 2007 dollars) were examined. Hospitalizations for subdural hematoma increased from 59,373 (30 per 100,000 hospitalizations) in 1998 to 91,935 (42 per 100,000) in 2007, constituting a 39% per-capita increase. The prevalence of subdural hematoma increased with age (p <.001), particularly among those > 80 yrs of age (36% of subdural hematoma cohort), in lower income patients, in patients with acquired abnormalities of the coagulation cascade, and in patients with trauma. Inhospital mortality decreased from 15% to 12% (p =.001), but unsatisfactory discharge disposition increased from 17% to 20% (p <.001). National cost increased from $ 1.0 to $ 1.6 billion (p <.001). Unsatisfactory discharge disposition and cost were both independently predicted by higher comorbidity index, alcohol abuse, history of trauma, and acquired abnormal coagulation or platelet factors (p <.05). Neurosurgical intervention for subdural hematoma decreased from 41% in 1998 to 31% in 2007 (p <.001). Subdural hematoma evacuation was associated with decreased mortality but did not significantly protect against poor discharge disposition and was associated with significantly higher cost. Conclusions: The prevalence and total cost for subdural hematoma has increased significantly in the last decade nationwide. Health resource consumption for subdural hematoma is increasing without clear evidence that management practices are leading to improved outcomes. (Crit Care Med 2011; 39: 1619-1625)