Stroke risk and outcomes in patients with traumatic brain injury: 2 nationwide studies.
OBJECTIVE
To investigate whether patients with traumatic brain injury (TBI) have an increased risk of stroke or poststroke mortality.


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 population.
Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan; Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan; School of Medicine, Taipei Medical University, Taipei, Taiwan.
Chien-Chang
CC
Liao
Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan.
Yi-Chun
YC
Chou
School of Medicine, Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.
Chun-Chieh
CC
Yeh
School of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Neurology, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.
Chaur-Jong
CJ
Hu
Graduate Institute of Injury Prevention and Control, Taipei Medical University, Taipei, Taiwan.
Wen-Ta
WT
Chiu
Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan; Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan; School of Medicine, Taipei Medical University, Taipei, Taiwan. Electronic address: tlc@tmu.edu.tw.
Ta-Liang
TL
Chen
D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000150:complications*; D016022:Case-Control Studies; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012306:Risk; D020521:Stroke / Q000209:etiology* / Q000401:mortality*; D013624:Taiwan / Q000453:epidemiology
COPD; HR; ICD-9-CM; International Classification of Diseases, Ninth Revision, Clinical Modification; OR; TBI; chronic obstructive pulmonary disease; hazard ratio; odds ratio; traumatic brain injury