Medical Student Albert Einstein College of Medicine Miami Beach, Florida, United States
Introduction: Subdural hematoma is a common disease requiring extensive care, with surgical evacuation as one of the most frequent forms of treatment. Despite the prevalence, reasons for re-operation and poor outcomes such as discharge to skilled nursing facilities (SNF) are not well understood. We have performed a retrospective review to analyze predictors of discharge to SNF after SDH in these patients.
Methods: Patients with a diagnosis of subdural hematoma who underwent surgical intervention were identified from a single urban institution between the years of 2015-2022. Patient variables, including lab values, demographics, comorbidities, prior anticoagulant use and imaging data, were collected from electronic medical records. Univariate and multivariate analysis was performed to identify predictors of discharge to SNF.
Results: A total of 329 patients were identified, of which 35 were excluded due to missing data. An additional 33 patients (11.2%) died during admission and were not included in discharge location analysis. Of the remaining 261 patients, 68 patients (23.1%) were discharged to a SNF. The remainder were discharged to acute rehab facilities or directly home. Univariate analysis showed significance as a predictor for discharge to SNF for age (above 75), seizures prior to admission, mental status and GCS on admission, as well as if the patient was not extubated post operatively. Upon multivariate analysis, history of dementia remained significant (p= < 0.001, OR 5.532), as well as greatest dimension of the subdural as measured from imaging (p=0.004, OR 1.903).
Conclusion : This review demonstrated that dementia was the most significant predictor for discharge to SNF, likely because patients with pre-existing dementia were often admitted to SNFs before presentation of the subdural. Greatest dimension of the subdural was also a significant predictor, but other factors like age or pre-operative anticoagulant use were surprisingly not. Further analysis will be beneficial to understand these outcomes.
