Predicting subdural hematoma outcomes as a function of PACE score

Objective: To investigate the relationship between the Patency after Coil Embolization (PACE) score and subdural hematoma resolution as defined by reduction in hematoma cross-sectional area. Methods: Patients with standalone coil middle meningeal artery embolization for subdural hematoma treatment were included in this study. Hematoma cross-sectional area (CSA) of the largest preoperative computed tomography (CT) slice and the corresponding postoperative CT slice, average Hounsfield units, and days between embolization and follow-up were recorded for each patient. A receiver operating characteristic (ROC) curve was used to determine the optimal threshold of hematoma resolution percentage at follow-up to differentiate between PACE score 0 and PACE score 1 embolizations. A multivariate logistic regression model of resolution above the calculated threshold adjusted for follow-up time, initial hematoma CSA, average Hounsfield units, and the PACE score was created. Results: A total of 43 patients with 63 hematomas (20 patients had bilateral hematomas) were included in this study. ROC curve calculated threshold for hematoma resolution was 70.9%. There were univariate statistically significant differences in follow-up time and hematoma size (p=0.021, p=0.006, respectively). In the multivariate model, the PACE score was the only statistically significant predictor of at least 70.9% hematoma resolution at follow-up. Conclusions: The PACE score is the most statistically significant predictor of at least 70.9% hematoma resolution at follow-up.