Data analysis of subdural hemorrhage by subgroup classification and ICD-10

Abstract

Subdural hemorrhage is a condition involving bleeding beneath the dura mater. In current medical referencing, the ICD-10 system is used, including codes S065 (Acute traumatic subdural hemorrhage) and I620 (Acute nontraumatic subdural hemorrhage). However, in clinical diagnosis, subdural hemorrhage is typically categorized as either acute or chronic. According to current theory, chronic subdural hemorrhage has distinct pathophysiological mechanisms and disease progression, which affects the accuracy and efficiency of data extraction for resource management and research purposes. This study aims to examine the patterns of prognosis and resource utilization in subdural hemorrhage by comparing ICD-10 codes with classification based on disease mechanisms. The research was conducted as a retrospective descriptive study, using data from patients diagnosed with subdural hemorrhage at Suranaree Camp Hospital from August 1, 2020, to July 31, 2024. Patients were reclassified into three groups based on pathophysiology: Acute traumatic subdural hemorrhage (atSDH), Acute non-traumatic subdural hemorrhage (antSDH), and Membrane-associated subdural hemorrhage (mSDH). The study then analyzed variables that represent the characteristics of each group. Among the 95 selected cases, ICD-10 code S065 accurately referred to the atSDH group in 100% of cases, and I620 accurately referred to the antSDH group in 100% of cases as well. However, 22 patients (40%) in the mSDH group were classified under S065, and 33 patients (60%) under I620. Further analysis showed that the mSDH group had the lowest mortality rate, and most inpatient treatments involved surgical intervention. In conclusion, classifying subdural hemorrhage based on disease mechanisms provides a clearer representation of the disease than using ICD-10 codes alone. Clinical diagnoses such as "Chronic subdural hemorrhage" or "Acute on-top chronic subdural hemorrhage" may be categorized under either S065 or I620, depending on the coder’s interpretation. Therefore, it is recommended to introduce a standardized code to specifically refer to chronic subdural hemorrhage or clinical diagnostic terms such as “Membrane-associated subdural hemorrhage (mSDH)” for improved accuracy in data use and medical classification.

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