Trajectory and Risk Factors of Acute Spontaneous Subdural Hematoma Complicating Course of Hospitalization in Critically Ill Patients: A Five-Year Case Series Study

Abstract

Background: Acute spontaneous subdural hematoma SDH is an uncommon but critical condition in critically ill patients. While chronic SDH is more frequent, the trajectory and risk factors of acute spontaneous SDH in such patients have been underreported. Aim: This study aims to analyze the trajectory and identify the risk factors for acute spontaneous SDH among critically ill patients. Objective: The objectives are to assess the risk factors associated with acute spontaneous SDH, understand its progression during hospital stays, and evaluate the impact of timely diagnosis and management on patient outcomes. Materials and Methods: Over a five-year period from April 2019 to April 2024, we conducted a retrospective analysis of 9 critically ill patients who developed acute spontaneous SDH during their course in the hospital. Data on demographics, co-morbidities, risk factors, hospital course, and outcomes, including a 90-day follow-up, were collected and analyzed. Results: The study identified several key risk factors prevalent among the patients with acute spontaneous SDH of which age, use of antiplatelet, previous cardiac intervention were major contributors, while hypertension, chronic alcohol use, renal insufficiency were also noted. The trajectory showed poor prognosis with a significant increase in length of stay in the ICU 11.3days, co-relating with a high APACHE IV 71.4. Risk of HAI is seen increased with 1 case of VAP and 1 reported CAUTI. The outcome showed 66.6%% 180-day mortality and severe morbidity or 44.4% mortality during hospital stay. Conclusion: This study provides insight into the significant risk factors and clinical trajectory of acute spontaneous SDH in complicating course of hospitalization in critically ill patients. The findings underscore the importance of active surveillance in highrisk individuals, monitoring for new sensory or motor deficits, early detection and protocoled treatment among such patients. The severe outcome results stress the need for extra vigilance in critically ill patients complicated by acute SDH during the course of admission. Future studies should aim to include larger sample sizes and multicenter data to validate these findings and improve the generalizability of the results.