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  • Risk Factors for Renal Failure in Patients with Traumatic Subdural Hematoma

    Final Number:

    David Rafael Santiago-Dieppa MD; Joel Martin MD; Michael G Brandel BA; Peter Abraham BA; Keiko M Kang; Todd Constantini MD; Alexander Arash Khalessi MD, MS

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2018 Annual Meeting

    Introduction: While renal dialysis is a known risk factor for subdural hematoma and is associated with worse outcomes, the incidence of renal failure (RF) complicating an admission for traumatic subdural hematoma (tSDH) remains unknown. Therefore, the purpose of this study is to determine the incidence and risk factors for RF following tSDH.

    Methods: Data were prospectively collected for consecutive tSDH admissions at our institution from 1990-2015. Predictors of RF were determined using multivariate logistic regression adjusted for demographic and clinical variables. R version 3.3.1 was used for statistical analysis and significance was defined as p <0.05.

    Results: Of 3024 tSDH patients (2211 male, 813 female), 59 (2.0%) experienced RF. On multivariate analysis, several positive risk factors for RF were identified: age 70-79 (OR=2.4, 95% CI 1.2-4.9, p=0.01), injury severity score (ISS)>=20 (OR=3.0, 95% CI 1.5-5.9, p<0.01), trauma injury severity score (TRISS) 0-75 (OR=1.8, 95% CI 1.1-3.1, p=0.03, length of stay (LOS)>=7 days (OR=8.3, 95% CI 4.3-16.1, p<0.01), ICU LOS>=7 days (OR=11.1, 95% CI 6.0-20.5, p<0.01, repeat craniotomy (OR=3.2, 95% CI 1.0-10.1, p=0.04), pneumonia (OR=3.1, 95% CI 1.4-6.8, p<0.01), and cardiac arrest (OR=3.4, 95% CI 1.2=9.7, p=0.02). In contrast, negative risk factors for RF included Glasgow Coma Scale (GCS) score 3-8 (OR=0.3, 95% CI 0.1-0.9, p=0.03), intubation required upon admission (OR=0.3, 95% CI 0.1-1.0, p=0.05), and sedation given upon admission (OR=0.2, 95% CI 0.1-0.9, p=0.03).

    Conclusions: Older patients with moderate-severe injuries and complicated admissions for tSDH, but not those obtunded with GCS 3-8 and requiring intubation, were at greatest risk for renal failure. This information may improve risk stratification and prevention of adverse in-hospital sequelae of tSDH.

    Patient Care: Identification of risk factors for renal failure following admission for traumatic subdural hematoma may lead to earlier diagnosis and treatment.

    Learning Objectives: 1. Identify risk factors for renal failure for patients admitted with traumatic subdural hematoma.

    References: 1. Lukasiewicz AM, Grant RA, Basques BA, Webb ML, Samuel AM, Grauer JN (2016) Patient factors associated with 30-day morbidity, mortality, and length of stay after surgery for subdural hematoma: a study of the American College of Surgeons National Surgical Quality Improvement Program. J Neurosurg 124: 760-766 doi:10.3171/2015.2.JNS142721

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