Introduction: Middle meningeal artery (MMA) embolization is an effective treatment for chronic subdural hematomas (cSDH). We incorporated an automated ICH detection platform to evaluate and triage cSDH patients. In addition, we evaluated the potential financial impact as well as length of stay with the MMA embolization procedure.
Methods: Images from alerts were reviewed. Subdural hematomas (SDH) were categorized as chronic or acute. Images and medical records were reviewed to determine eligibility for MMA embolization. Financial analysis was performed by calculating the difference in reimbursement for DRGs for medical management and surgical treatment of intracerebral hemorrhage.
Results: Over a 3-month period, 98 patients were found to have SDHs; 49 cSDH and 49 acute. In patients with cSDH, 39 (80%) were appropriate for intervention. 27 patients underwent a cranial procedure; 4 had surgery plus MMA embolization, 1 MMA embolization alone. In the surgical cohort 7 of 27 patients were suitable for either MMA embolization or surgery and 4 were appropriate for MMA embolization after surgery. In patients not undergoing an intervention, 11 of 21 were candidates for MMA embolization and 9 of the 11 were lost to follow up.
In total, 25 patients met criteria for MMA embolization. Extrapolation for a 12-month interval estimated 100 MMA embolization procedures and 56 patients lost to follow up. The prospective reimbursement for patients who were appropriate for MMA embolization but observed was calculated to be $1,250,703. The difference in LOS for 28 patients who underwent surgery rather than MMA embolization amounted to 110 extra hospital days.
Conclusion : Artificial intelligence is a useful tool for coordinating the care of patients with chronic subdural hematomas and can reduce those lost to follow up. MMA embolization may provide additional revenue streams for a stroke service line while also providing a significant decrease in LOS providing more beds for other patients.
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