Abstract：
BACKGROUND: This study quantifies the impact of middle meningeal artery embolization (MMAE) for subdural hematomas (SDHs) by estimating a target population.
METHODS: A population-based study at a tertiary hospital, the main SDH facility for a four-county population, used primary ICD-10 codes over 3 years to collate SDH hospitalizations. Clinical and imaging data confirmed traumatic versus non-traumatic and acute versus non-acute (mixed or chronic) SDH. The MMAE-eligible population included patients with non-traumatic, non-acute SDH aged ≥18 years plus patients with \'traumatic\' but non-acute SDH aged ≥60 years presenting with a fall. This was contrasted with the rate of large vessel strokes in the same population.
RESULTS: 1279 hospitalizations with a primary ICD-10 SDH diagnosis were identified, with 389 from the study population. Excluding repeat admissions, 350 patients were analyzed, 233 (67%) traumatic, and 117 (33%) non-traumatic SDH. Regarding etiology, \'fall ≥60 years\' was the most common category in the entire cohort (n=156; 45% (95% CI 39% to 50%)). The SDH rate was 52/100 000 persons/year (95% CI 47 to 57). The rate of all non-traumatic, non-acute SDH in patients aged ≥18 years was 17/100 000 persons/year (95% CI 15 to 20), combining with \'traumatic\' but non-acute fall-related SDH in patients aged ≥60 years yielded 41/100 000 persons/year (95% CI 36 to 47). This demographic may represent an MMAE-eligible population, exceeding large vessel stroke rates (31/100 000 persons/year) in the same population, estimating 139 387 potential MMAE cases/year (95% CI 121 517 to 158 168) in the USA.
CONCLUSIONS: MMAE could transform non-acute SDH management, especially in the elderly, potentially surpassing the impact of large vessel stroke. Clinical trials are essential for validation of its efficacy and safety compared with standard management.
METHODS: A population-based study at a tertiary hospital, the main SDH facility for a four-county population, used primary ICD-10 codes over 3 years to collate SDH hospitalizations. Clinical and imaging data confirmed traumatic versus non-traumatic and acute versus non-acute (mixed or chronic) SDH. The MMAE-eligible population included patients with non-traumatic, non-acute SDH aged ≥18 years plus patients with \'traumatic\' but non-acute SDH aged ≥60 years presenting with a fall. This was contrasted with the rate of large vessel strokes in the same population.
RESULTS: 1279 hospitalizations with a primary ICD-10 SDH diagnosis were identified, with 389 from the study population. Excluding repeat admissions, 350 patients were analyzed, 233 (67%) traumatic, and 117 (33%) non-traumatic SDH. Regarding etiology, \'fall ≥60 years\' was the most common category in the entire cohort (n=156; 45% (95% CI 39% to 50%)). The SDH rate was 52/100 000 persons/year (95% CI 47 to 57). The rate of all non-traumatic, non-acute SDH in patients aged ≥18 years was 17/100 000 persons/year (95% CI 15 to 20), combining with \'traumatic\' but non-acute fall-related SDH in patients aged ≥60 years yielded 41/100 000 persons/year (95% CI 36 to 47). This demographic may represent an MMAE-eligible population, exceeding large vessel stroke rates (31/100 000 persons/year) in the same population, estimating 139 387 potential MMAE cases/year (95% CI 121 517 to 158 168) in the USA.
CONCLUSIONS: MMAE could transform non-acute SDH management, especially in the elderly, potentially surpassing the impact of large vessel stroke. Clinical trials are essential for validation of its efficacy and safety compared with standard management.
摘要：
背景：这项研究通过估计目标人群来量化脑膜中动脉栓塞（MMAE）对硬膜下血肿（SDH）的影响。
方法：在三级医院进行的基于人群的研究，为四个县人口提供的主要SDH设施，使用3年以上的主要ICD-10代码来整理SDH住院情况.临床和影像学数据证实了创伤性与非创伤性和急性与非急性（混合或慢性）SDH。符合MMAE资格的人群包括非创伤性患者，年龄≥18岁的非急性SDH加上患有“创伤性”的患者，但年龄≥60岁的非急性SDH伴有跌倒。这与相同人群中大血管中风的比率形成对比。
结果：确定了1279例主要诊断为ICD-10SDH的住院治疗，389来自研究人群。不包括重复录取，350名患者进行了分析，233（67%）创伤，和117（33％）非创伤性SDH。关于病因学，“跌倒≥60岁”是整个队列中最常见的类别(n=156;45%(95%CI39%至50%))。SDH率为52/10万人/年(95%CI47至57)。所有非创伤性的比率，年龄≥18岁患者的非急性SDH为17/100000人/年（95%CI15至20），在≥60岁的患者中，与“创伤性”但非急性跌倒相关的SDH合并产生41/100000人/年（95％CI36至47）。此人口统计可能代表符合MMAE资格的人口，在同一人群中超过大血管中风率(31/100000人/年)，估计美国139387例潜在MMAE病例/年(95%CI121517至158168)。
结论：MMAE可以改变非急性SDH治疗，尤其是老年人，有可能超越大型船只冲程的影响。与标准管理相比，临床试验对于验证其有效性和安全性至关重要。
方法：在三级医院进行的基于人群的研究，为四个县人口提供的主要SDH设施，使用3年以上的主要ICD-10代码来整理SDH住院情况.临床和影像学数据证实了创伤性与非创伤性和急性与非急性（混合或慢性）SDH。符合MMAE资格的人群包括非创伤性患者，年龄≥18岁的非急性SDH加上患有“创伤性”的患者，但年龄≥60岁的非急性SDH伴有跌倒。这与相同人群中大血管中风的比率形成对比。
结果：确定了1279例主要诊断为ICD-10SDH的住院治疗，389来自研究人群。不包括重复录取，350名患者进行了分析，233（67%）创伤，和117（33％）非创伤性SDH。关于病因学，“跌倒≥60岁”是整个队列中最常见的类别(n=156;45%(95%CI39%至50%))。SDH率为52/10万人/年(95%CI47至57)。所有非创伤性的比率，年龄≥18岁患者的非急性SDH为17/100000人/年（95%CI15至20），在≥60岁的患者中，与“创伤性”但非急性跌倒相关的SDH合并产生41/100000人/年（95％CI36至47）。此人口统计可能代表符合MMAE资格的人口，在同一人群中超过大血管中风率(31/100000人/年)，估计美国139387例潜在MMAE病例/年(95%CI121517至158168)。
结论：MMAE可以改变非急性SDH治疗，尤其是老年人，有可能超越大型船只冲程的影响。与标准管理相比，临床试验对于验证其有效性和安全性至关重要。
