Do Patients With SDH ≤3 mm Require Surgery?

Background: The incidence of subdural hematomas (SDHs) is increasing due to the aging population, falls, and increasing use of anticoagulants and antiplatelet therapies. Some acute SDHs expand and require urgent surgical intervention while some remain stable. Objective: To identify predictors of acute SDH enlargement to help in clinical management. Design: Retrospective study. Methods: 32,401 noncontrast CT brain scans were evaluated during a 6-year study period. A total of 262 acute SDHs were observed. Demographic, clinical, and radiologic factors associated with hematoma enlargement and need for surgical intervention were noted. Results: SDH enlargement occurred in 25% of patients. Larger initial SDH size, concurrent subarachnoid hemorrhage (SAH), hypertension, convexity location, and midline shift were significantly associated with hematoma expansion. No patient with an initial SDH ≤3 mm required surgery initially or in follow-up (despite 11.1% showing enlargement to maximum width more...