Deep Dissecting Hematoma, an Often Misdiagnosed Lesion: Case-Control Analysis of Risk Factors and Wound-Healing Prognosis

Abstract

Objectives: Deep dissecting hematomas (DDHs) represent severe acute wounds, predominantly affecting older patients. This study aimed to identify DDH risk factors and analyze factors associated with good wound-healing prognosis.

Design: Retrospective, multicenter, case-control study from January 2016 to March 2022.

Setting and participants: A total of 240 patients, 60 patients with DDH and 180 controls with venous or arterial ulcers.

Methods: Primary endpoint was analysis of demographic and clinical parameter differences between patients and controls to identify DDH risk factors. Secondary endpoint was analysis of DDH-wound healing to identify factors associated with good prognosis defined as ≥40% healing of the initial wound 1 month after debridement.

Results: Patients were mainly female (n = 47, 78%), 63% misdiagnosed, median age: 87 years, and median Cumulative Illness Rating Scale (CIRS) score: 20/56. The low limb was the main DDH localization. Thirty-three (55%) patients had dermatoporosis, 53 (88%) were malnourished, and 51 (85%) had peripheral vascular disease. DDH developed post-trauma in 42 (70%) patients, with 29 (48%) of them resulting from falls. Half of the patients experienced DDH complications: acute anemia (n = 31, 52%) and local infection requiring oral antibiotics (n = 22, 37%). Time to starting appropriate care was significantly longer when the first DDH consultation was outside our expert center. DDH was significantly associated [adjusted OR (95% CI)] with low-molecular-weight heparin [1.95 (5.12-92.1); P < .001], dermatoporosis [3.75 (1.63-9.04); P = .002], age [1.09 (1.02-1.17); P = .02], and CIRS score [1.08 (1.01-1.17); P = .05]. Chemotherapy was significantly associated with delayed wound healing (P = .03) and age (P = .04) and skin grafting within 1 month (P = .003) were significantly associated with good wound healing.

Conclusions and implications: This analysis of DDH risk factors based on a case-control study of a large geriatric cohort identified novel results on prognostic factors for DDH healing. Larger prospective studies are needed to extend our findings.

Keywords: Deep dissecting hematomas; antithrombotic treatments; dermatoporosis; emergency medicine; older adults; wound healing.