Research Reports - Stroke risk and outcomes in patients with traumatic brain injury

Mayo Clin Proc. 2014 Feb;89(2):163-72

Liao CC(1), Chou YC(2), Yeh CC(3), Hu CJ(4), Chiu WT(5), Chen TL(6)

OBJECTIVE: To investigate whether patients with traumatic brain injury (TBI) have
an increased risk of stroke or poststroke mortality.
PARTICIPANTS AND METHODS: Using Taiwan's National Health Insurance Research
Database, we conducted a retrospective cohort study of 30,165 patients with new
TBI and 120,660 persons without TBI between January 1, 2000, and December 31,
2004. The risk of stroke was compared between 2 cohorts through December 31,
2008. To investigate the association between in-hospital mortality after stroke
and history of TBI, we conducted a case-control study of 7751 patients with newly
diagnosed stroke between January 1, 2005, and December 31, 2008.
RESULTS: The TBI cohort had an increased stroke risk (hazard ratio [HR], 1.98;
95% CI, 1.86-2.11). Among patients with stroke, those with a history of TBI had a
higher risk of poststroke mortality compared with those without TBI (odds ratio,
1.57; 95% CI, 1.13-2.19). In the TBI cohort, factors associated with stroke were
history of TBI hospitalization (HR, 3.14; 95% CI, 2.77-3.56), emergency care for
TBI (HR, 3.37; 95% CI, 2.88-3.95), brain hemorrhage (HR, 2.69; 95% CI,
2.43-2.99), skull fracture (HR, 3.00; 95% CI, 2.42-3.71), low income (HR, 2.65;
95% CI, 2.16-3.25), and high medical expenditure for TBI care (HR, 2.26; 95% CI,
2.09-2.43). The severity of TBI was also correlated with poststroke mortality.
CONCLUSIONS: Traumatic brain injury was associated with risk of stroke and
poststroke mortality. The relationship between TBI and poststroke mortality does
not seem to transcend all age groups. This research shows the importance of
prevention, early recognition, and treatment of stroke in this vulnerable

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