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The SafeSDH prediction tool can help to identify patients with subdural hematoma (SDH) who may not necessitate a higher level of care (either ICU stay or interfacility transfer) and can safely be monitored in the community or lower acuity setting.
Transfers are really a pain in the neck head
This was a retrospective chart review of patients who presented with an isolated SDH to 1 of 6 hospitals (predominantly academic). Primary outcome was a composite of neurologic deterioration, neurosurgical intervention, discharge on hospice, and death. The goal was external validation of the SafeSDH tool that was originally published in 2017. Importantly, patients were excluded and not considered low risk if they were on anticoagulant or non-aspirin antiplatelet agent, had a Glasgow Coma Score (GCS) < 14, more than 1 discrete hematoma, hematoma thickness > 5mm, or midline shift. In this validation cohort, the tool demonstrated sensitivity of 99% (95%CI 96-100) and specificity of 31% (95%CI 27-35) with a negative likelihood ratio of 0.03 (95%CI 0.01-0.11). This compares to a sensitivity of 96% and specificity of 29% on internal validation cohort with initial publishing of the tool. There were only two false negatives both of whom had decompensation from a medical standpoint and not the SDH itself.
Source
External Validation of a Tool to Identify Low-Risk Patients With Isolated Subdural Hematoma and Preserved Consciousness. Ann Emerg Med. 2024 May;83(5):421-431. doi: 10.1016/j.annemergmed.2023.08.481. Epub 2023 Sep 19. PMID: 37725019.
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