Falcine and Tentorial Subdural Hematomas May Not Routinely Require Transfer to a Tertiary Care Center

J Emerg Med. 2015 Nov;49(5):679-85. doi: 10.1016/j.jemermed.2015.06.055. Epub 2015 Aug 14.

Abstract

Background: Patients with subdural hematomas (SDH) are frequently transferred to tertiary care centers. Although many prognostic factors, treatment strategies, and outcomes for convexity SDH have been reported, little is known about falcine and tentorial SDH.

Objectives: To describe features and outcomes of isolated falcine and tentorial SDH.

Methods: We reviewed clinical/radiographic findings, treatment, length of stay (LOS), and outcome of adult patients transferred to a tertiary care center for acute SDH. Characteristics of patients with isolated falcine/tentorial SDH and outcomes (favorable [discharge to home/acute rehabilitation] vs. unfavorable [death/hospice/skilled nursing facility/long term care]) were assessed with univariate analyses.

Results: Of 210 patients with SDH, mean age was 69.5 years; 117 were male; 98 (47%) underwent surgical SDH evacuation. Twenty-seven patients had isolated falcine or tentorial SDH, with known traumatic etiology in 23. None of the falcine/tentorial SDH patients required surgery or intubation. Compared with convexity SDH, patients with falcine/tentorial SDH were younger (59.7 vs. 70.9 years, p = 0.01), had higher admission Glasgow Coma Scale scores at the referring (p = 0.01) and receiving facility (p = 0.004), and shorter median intensive care unit LOS (1 vs. 3, p < 0.0001). All patients (100%) with falcine/tentorial SDH had favorable outcome vs. 68% with convexity SDH (p = 0.0005).

Conclusion: Isolated tentorial/falcine SDH without associated neurological deficits represent a benign entity among acute SDH, with no need for surgical intervention, short LOS, and favorable outcome. Our data indicate that for these patients, in the absence of complicating factors, transfer to a tertiary care center may not be routinely indicated.

Keywords: falcine and tentorial subdural hematoma; neurocritical care; subdural hematoma; tertiary care center; transfer; triage.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Female
  • Glasgow Coma Scale
  • Hematoma, Subdural, Acute / diagnostic imaging*
  • Hematoma, Subdural, Acute / therapy*
  • Humans
  • Intensive Care Units
  • Length of Stay
  • Male
  • Middle Aged
  • Patient Transfer*
  • Radiography
  • Retrospective Studies
  • Tertiary Care Centers*
  • Treatment Outcome