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Management of acute subdural hematoma in incarcerated patients

Shahrestani, Shane and Strickland, Ben A. and Micko, Alexander and Brown, Nolan J. and Zada, Gabriel (2021) Management of acute subdural hematoma in incarcerated patients. Clinical Neurology and Neurosurgery, 201 . Art. No. 106441. ISSN 0303-8467.

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Introduction: Incarcerated patients have been documented to have higher rates of mental illness, substance abuse disorders, trauma, and chronic illnesses compared to non-incarcerated populations. In this study, we evaluated the incidence of subdural hematoma (SDH) in incarcerated patients and compared the outcomes of these patients to those of non-incarcerated patients. Methods: We conducted a retrospective cohort study of incarcerated patients admitted to a hospital with acute SDH using the Nationwide Readmissions Database between 2016−2017. Nearest-neighbor propensity score matching for demographics was implemented to identify non-incarcerated control patients admitted with SDH. Analysis used chi-squared testing, Mann-Whitney U testing, and generalized binomial regression modeling. Results: A total of 962 incarcerated and non-incarcerated patients were identified at primary admission. No significant difference was found between the two cohorts with regards to rates of neurosurgical complications or readmissions. Incarcerated patients were found to receive a significantly lower number of procedures, including respiratory ventilation, intubation, central venous line placement, and imaging, during their primary admission (NPR = 2.7 ± 4.0) compared to non-incarcerated patients (NPR = 3.9 ± 4.9) (p = 0.00050), reduced length of stay (p = 0.0052), and reduced hospital costs (p = 0.00026) compared to non-incarcerated patients. Furthermore, female incarcerated patients with SDH had significantly worse outcomes compared to male patients with SDH, including higher rates of mortality (p = 0.0017) and 30-day readmission rates (p = 0.041). Discussion: Our study suggests that incarcerated patients may receive significantly fewer diagnostic and supportive procedures while admitted for SDH and may be discharged sooner than non-incarcerated patients with SDH. In addition, outcomes following SDH within incarcerated patients may be significantly worse for females.

Item Type:Article
Related URLs:
URLURL TypeDescription
Shahrestani, Shane0000-0001-7561-4590
Micko, Alexander0000-0001-9105-3519
Brown, Nolan J.0000-0002-6025-346X
Zada, Gabriel0000-0001-5821-902X
Additional Information:© 2020 Elsevier B.V. Received 20 October 2020, Revised 5 December 2020, Accepted 13 December 2020, Available online 15 December 2020. CRediT authorship contribution statement: Shane Shahrestani: Conceptualization, Methodology, Software, Formal analysis, Data curation, Writing - original draft, Writing - review & editing. Ben A. Strickland: Supervision, Project administration, Writing - review & editing. Alexander Micko: Supervision, Project administration, Writing - review & editing. Nolan J. Brown: Supervision, Project administration, Writing - review & editing. Gabriel Zada: Supervision, Project administration, Writing - review & editing. There are no conflicts of interest in this study. There are also no disclosures of funding for this study. No patient identifiers were collected. Institutional Review Board (IRB) approval was not necessary as this study utilized a publicly available de-identified dataset.
Subject Keywords:Subdural; Hemorrhage; Neurosurgery; Incarcerated; Prison
Record Number:CaltechAUTHORS:20210107-130950047
Persistent URL:
Official Citation:Shane Shahrestani, Ben A. Strickland, Alexander Micko, Nolan J. Brown, Gabriel Zada, Management of acute subdural hematoma in incarcerated patients, Clinical Neurology and Neurosurgery, Volume 201, 2021, 106441, ISSN 0303-8467, (
Usage Policy:No commercial reproduction, distribution, display or performance rights in this work are provided.
ID Code:107365
Deposited By: Tony Diaz
Deposited On:08 Jan 2021 17:54
Last Modified:08 Jan 2021 17:54

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