Key result
Strict SBP control of 100-150 mmHg shows no 30-day mortality benefit after acute subdural hematoma.
Why the study?
Optimal systolic blood pressure targets after traumatic subdural hematoma remain debated due to balancing cerebral perfusion benefits against hematoma expansion risks.
Does maintaining SBP 100-150 mmHg compared to SBP <180 mmHg reduce 30-day mortality in patients with acute traumatic subdural hematoma?
Cohort (n=2,486)
Yes
Does maintaining SBP 100-150 mmHg compared to SBP <180 mmHg reduce 30-day mortality in patients with acute traumatic subdural hematoma?
In patients with acute traumatic subdural hematoma, maintaining SBP at 100-150 mmHg versus <180 mmHg within the first 24 hours did not significantly affect 30-day mortality or secondary clinical outcomes.
Answers are grounded in this paper and cite their sources.
No mortality difference between SBP 100-150 versus <180 mmHg targets; leaves open optimal BP goals in acute traumatic SDH pending prospective data.
Background There is debate over optimal systolic blood pressure (SBP) after traumatic subdural hematoma. Increased SBP has the benefit of increasing cerebral perfusion pressure and limiting the detrimental secondary effects of traumatic brain injury but poses a risk of hematoma expansion. While prior studies have shown that SBP<90mmHg is associated with worsened morbidity and mortality in subdural hematoma patients, clinical guidelines and expert opinion have differing initial SBP goals. The aim of this study is to leverage a large database to determine the effects of two such goals, namely SBP 100-150mmHg versus SBP<180mmHg in this patient population. Methods A de-identified database network (TriNetX Research Network) was used to retrospectively query all patients with a first instance diagnosis of acute traumatic SDH, who also had a recorded GCS, with maintenance of SBP 100-150 within the first 24 hours (cohort 1) versus patients with an SBP<180 (cohort 2). Data came from 68 health care organizations (HCOs) with a total of 105,897,964 patients on 9/1/2022. The primary outcome of interest was mortality within 30 days. Secondary outcomes include gastrostomy tube placement, craniotomy/craniectomy/burr hole drainage, venous thromboembolism, ischemic stroke, myocardial infarction, seizure, falls, cardiac arrest, and acute kidney injury within 30 days. Cohorts were propensity-score matched for confounders. Results After propensity score matching, 1,243 patients were identified in each cohort. Age at index was 57.97+/-23.21 years and 58.28+/-22.35 years for cohorts 1 and 2, respectively. Mortality was seen in 243 patients (19.756%) vs. 209 (16.992%) (OR 1.203, 95% CI (0.98,1.476), p=0.0767) in cohorts 1 and 2, respectively. There was no statistical difference in secondary outcomes. Conclusion The results of this study demonstrate that the primary outcome of mortality at 30 days is not statistically different in acute traumatic SDH patients, whether their SBP is kept at 100-150 or below 180. Likewise, it shows no statistical difference in the subsequent incidence of gastrostomy tube placement, craniotomy/craniectomy/burr holes, venous thromboembolism, ischemic stroke, myocardial infarction, seizure, falls, or acute kidney injury.
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David R Hallan (2022) conducted a cohort in Acute traumatic subdural hematoma (n=2,486). Maintenance of SBP 100-150 mmHg vs. Maintenance of SBP <180 mmHg was evaluated on Mortality within 30 days (OR 1.203, 95% CI 0.98-1.476, p=0.0767). Maintaining systolic blood pressure between 100-150 mmHg compared to <180 mmHg in the first 24 hours after acute traumatic subdural hematoma did not significantly affect 30-day mortality (OR 1.203).
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