Grant funds first-ever population-level study of subdural hematomas

The University of Cincinnati Gardner Neuroscience Institute’s David Robinson, MD, is leading the first-ever population-level study of subdural hematoma outcomes in the United States, funded by the National Institute of Neurological Disorders and Stroke.

Robinson said subdural hematomas can be caused by major head traumas such as car accidents, but they are also associated with minor falls in which people do not directly hit their heads. Bleeds like these are more common in elderly people.

“There are pockets within that population, depending on the exact characteristics, where you can have better or worse outcomes,” said Robinson, assistant professor in the Department of Neurology and Rehabilitation Medicine in UC’s College of Medicine. “And one of the reasons why some people are more likely to develop these than others is related to whether they’re on medications that thin their blood.”

Robinson explained many elderly patients take blood thinners to prevent their risk of a heart attack or stroke. But these same medications put patients at a higher risk for another bleeding event after an initial subdural hematoma.

“One of the key goals of my study is to understand how the risks balance out,” Robinson said. “Should we be most worried about whether they’re going to develop complications like heart attack and stroke, or should we be much more worried about them having future bleeding events and thinking of new ways to reduce their chances of heart attacks and strokes without putting them on blood thinning medication?”

To answer this question, Robinson is utilizing the infrastructure of the Greater Cincinnati Northern Kentucky Stroke Study (GCNKSS) to follow patients with subdural hematomas for three years after initial diagnosis.

“The GCNKSS has been doing this sort of work since 1993, but it’s never included subdural hematomas before,” Robinson said. “The core infrastructure allows us to do the same population research, just expanding it to subdural hematomas.”

With the data collected, the team is aiming to use advanced machine learning to develop predictive models of who’s more likely to have another subdural hematoma and who’s more likely to develop heart attacks and strokes after an initial bleeding event.

“The idea is these advanced machine learning models might help us better assess who really needs to be back on blood thinning medicine as soon as possible and who is at such a risk of bleeding that we probably shouldn’t put them back on a blood thinning medicine,” he said.

This knowledge could lead to a more personalized approach for each patient, and Robinson said this initial data will hopefully lead to randomized clinical trials to confirm which patients should go back on blood thinners.