title: Patients with traumatic brain injury: population-based study suggests increased risk of stroke.
abstract: OBJECTIVE
  Previous studies have identified an array of morbidities following traumatic brain injury (TBI), including certain neurological disorders. However, no direct evidence has been reported on the link between TBI and stroke. This population-based study was designed to estimate the risk of stroke during a period of 5 years following a TBI, compared with individuals who did not suffer TBI during the same period.
  
  
  METHODS
  Data were obtained from the Longitudinal Health Insurance Database 2000 (LHID 2000). A total of 23 199 patients receiving ambulatory or hospitalization care with a diagnosis of TBI were included, together with 69 597 non-TBI patients as our comparison group, matched by sex, age, and year of index use of health care. Each individual was followed for 5 years to identify subsequent occurrence of stroke. Cox proportional hazard regressions were performed for analysis.
  
  
  RESULTS
  During the 3-month follow-up period, 675 strokes (2.91%) occurred in TBI patients and in 207 patients (0.30%) in the non-TBI comparison cohort. A diagnosis of TBI was independently associated with a 10.21 (95% CI, 8.71-11.96), 4.61 (95% CI, 4.16-5.11), and 2.32 (95% CI, 2.17-2.47) times greater risk of stroke during 3-month, 1-year, and 5-year follow-up, respectively, after adjusting for sociodemographic characteristics and selected comorbidities. The risk of intracerebral hemorrhage was more noticeable among patients with TBI compared with those without a TBI.
  
  
  CONCLUSIONS
  This is the first report showing an increased risk of stroke among individuals who have sustained a TBI. We suggest a need for more intensive medical monitoring and health education following TBI, especially during the first few months and years.
authors.affiliation: School of Public Health, Taipei Medical University, and Neuroscience Research Center, Taipei Medical University Hospital, 250 Wu-Hsing St., Taipei 110, Taiwan.
authors.forename: Yi-Hua
authors.initials: YH
authors.lastname: Chen
authors.forename: Jiunn-Horng
authors.initials: JH
authors.lastname: Kang
authors.forename: Herng-Ching
authors.initials: HC
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001930:Brain Injuries / Q000150:complications* / Q000453:epidemiology; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012306:Risk; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology*; D013624:Taiwan / Q000453:epidemiology