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Development and Preliminary Validation of a Risk Assessment Tool for Subdural Hematoma in Patients with Intracranial
Yiyan Huang1, Weipeng Huang2, Tan Xie3
1Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, 310016, China. hyy123@zju.edu.cn.
Background:
Approximately 20% of patients with intracranial hypotension develop subdural hematoma. Progressive hematoma expansion can cause brain compression and secondary ischemic injury, potentially leading to life-threatening cardiorespiratory failure. Brain computed tomography can detect subdural hematoma but misses subtle or milder intracranial hypotension changes, while no integrated model exists to predict this high-risk complication. This retrospective cohort study aims to develop a prediction tool to identify subdural hematoma risk in patients with intracranial hypotension.
Methods:
We identified patients with intracranial hypotension from a tertiary hospital in Hangzhou, China, between 2023 and 2024. Potential predictors of subdural hematoma were identified through literature review and expert consultation. Factors were screened using logistic regression. The final model was presented as a nomogram and was internally validated.
Results:
In 496 patients with intracranial hypotension (median age 37 years; 69.0% female), 22.0% developed subdural hematoma. The final model (Akaike information criterion (AIC), 454.17) demonstrated significant improvement over the null model (ΔAIC, [- 2.9]; p < 0.001) and incorporated eight predictors, including male sex (adjusted odds ratio [aOR], 1.99; 95% confidence interval [CI]: 1.22-3.24), older age (aOR, 1.01; 95% CI: 1.00-1.02), previous misdiagnosis of intracranial hypotension (aOR, 2.60; 95% CI: 1.35-5.03), history of meningitis (aOR, 10.63; 95% CI: 1.98-57.12), prior cranial neurosurgery (aOR, 7.60; 95% CI: 2.23-25.81), higher D-dimer (aOR, 1.87; 95% CI: 1.10-3.16), elevated white blood cell count (aOR, 1.12; 95% CI: 1.01-1.25), and elevated C-reactive protein levels (aOR, 1.04; 95% CI: 1.01-1.07). The nomogram demonstrated moderate discrimination (AUC, 0.77; 95% CI: 0.72-0.83) and good calibration.
Conclusions:
This study developed a clinical prediction model for subdural hematoma risk in patients with intracranial hypotension, incorporating eight key predictors. While the model shows excellent calibration that ensures clinically reliable risk estimates, future multicenter studies are still needed to further validate this tool.