Subdural Hematoma DRG CategoT 014

Mean LOS: 6.4 days Description: MEDICAL: Specific Cerebrovascular

Disorders, Except TIA DRG Category: 002 Mean LOS: 9.8 days Description: SURGICAL: Craniotomy for Trauma, Age > 17

Subdural hematoma (SDH) is an accumulating mass of blood, usually clotted, or a swelling that is confined to the space between the dura mater and the subarachnoid membrane. SDHs are space-occupying lesions and thus categorized as focal brain injuries, which account for approximately 50% of all head injuries and 60% of the mortality in head-injured patients. Sometimes an SDH is referred to as a mass lesion because it occupies critical space in the cranial vault. Deaths from SDH usually occur because of the expanding mass lesion that leads to excessive brain swelling and herniation, thus causing brain stem ischemia and hemorrhage.

SDHs are classified as either acute or chronic based on when symptoms appear. Acute SDHs have clinical findings that are evident within 24 to 72 hours after the traumatic event. A subacute SDH produces symptoms within 2 to 10 days; symptoms appear in chronic SDH within weeks or months (Table 3). Generally, head trauma involves both a primary injury and a secondary injury. The primary injury results from the initial impact, which causes immediate neurological damage and dysfunction. The secondary injury follows the initial trauma and probably stems from cerebral hypoxia and ischemia that then lead to cerebral edema, increased intracranial pressure (ICP),

• TABLE 3 Types of Subdural Hematomas
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