Objectives: In the United States, the prevalence of traumatic subdural hematoma (TSDH) continues to increase and currently accounts for 12% to 51.4% of all traumatic brain injuries. Using a nationally representative discharge records of hospitalized patients with TSDH, the study objectives were to estimate the inpatient cost, length of stay (LOS), inpatient mortality rate and complication rate among surgical and non-surgical cases; and to identify the effect of various socio-demographic, clinical and hospital characteristics on complications and inpatient death.

Methods: Hospital discharge records of patients with a primary diagnosis of TSDH were identified from the National Inpatient Sample (NIS) data for the years 2010-2017. Multivariate logistic regressions were utilized to compare the odds of inpatient death and complications during inpatient stay among surgical and non-surgical cases after adjusting for confounders as well as to measure the effect of various factors on inpatient death and any complications. A linear regression was also utilized to analyze the trend in number of discharge records, inpatient costs, and LOS across the study period.

Results: Among 114,464 cases identified with a primary diagnosis of TSDH, 56.81% were male and 22.11% had surgery. The mean inpatient cost was $23,180.54 (95% CI:$22,981.90–$23,379.19) and LOS was 6.41 days (95% CI:6.35–6.46). There was a significant increase in the number of cases per year by 1292 patients ( p=0.0022) and LOS (0.13 days; p=0.0478) from 2010 to 2017. Surgical interventions had a higher rate of inpatient mortality (10.5% vs 7.86%) and complications (26.52% vs 14.99%) than non-surgical cases and pulmonary complications was most common in both surgical and non-surgical cases. The highest odds of inpatient death were in urban teaching hospitals.

Conclusions: Given the increase in prevalence of TSDH in the United States, additional resources and efforts should be allocated towards improving patient outcomes and lowering healthcare costs.