title: Increased Risk of Stroke in Patients of Concussion: A Nationwide Cohort Study.
abstract: Long-term morbidities can develop after traumatic brain injury (TBI). Some studies have suggested that the risk of stroke is higher after TBI, but the association between concussion and stroke remains unclear. Using a national cohort, the authors analyzed the incidence of both hemorrhagic and ischemic strokes in patients with previous concussion. A representative cohort of approximately one million people was followed up for four years. Patients with new-onset concussion were identified (n= 13,652) as the concussion group. Subsequently, the incidence rates of later stroke events in the concussion group were compared to a sex-, age- and propensity score-matched comparison group (n= 13,652). The overall incidence rate of stroke in the concussion group was higher than that of the comparison group (9.63 versus 6.52 per 1000 person-years,p< 0.001). Significantly higher stroke risk was observed in the concussion group than in the comparison group (crude hazard ratio 1.48,p< 0.001; adjusted HR 1.65,p< 0.001). In the concussion group, the cumulative incidence rates of both ischemic stroke and hemorrhagic stroke were higher than those of the comparison group (8.9% vs. 5.8% and 2.7% vs. 1.6%, respectively, bothp< 0.001). Concussion is an independent risk factor for both ischemic and hemorrhagic strokes. Prevention and monitoring strategies of stroke are therefore suggested for patients who have experienced concussion.
authors.affiliation: Department of Emergency Medicine, National Yang-Ming University Hospital, I-Lan 260, Taiwan. shihweiliu123@gmail.com.
authors.forename: Shih-Wei
authors.initials: SW
authors.lastname: Liu
authors.affiliation: Department of Emergency Medicine, National Yang-Ming University Hospital, I-Lan 260, Taiwan. horus7855@yahoo.com.tw.
authors.forename: Liang-Chung
authors.initials: LC
authors.lastname: Huang
authors.affiliation: Department of Emergency Medicine, National Yang-Ming University Hospital, I-Lan 260, Taiwan. wolfchung2001@yahoo.com.tw.
authors.forename: Wu-Fu
authors.initials: WF
authors.lastname: Chung
authors.affiliation: Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei 112, Taiwan. hsuankanchang@gmail.com.
authors.forename: Hsuan-Kan
authors.initials: HK
authors.lastname: Chang
authors.affiliation: Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei 112, Taiwan. 12206@ymuh.ym.edu.tw.|School of Medicine, National Yang-Ming University, Taipei 112, Taiwan. 12206@ymuh.ym.edu.tw.
authors.forename: Jau-Ching
authors.initials: JC
authors.lastname: Wu
authors.affiliation: Department of Emergency Medicine, National Yang-Ming University Hospital, I-Lan 260, Taiwan. jauching@gmail.com.|School of Medicine, National Yang-Ming University, Taipei 112, Taiwan. jauching@gmail.com.
authors.forename: Li-Fu
authors.initials: LF
authors.lastname: Chen
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei 112, Taiwan. hc_cheng@vghtpe.gov.tw.|Department of Medical Research and Education, National Yang-Ming University Hospital, I-Lan 260, Taiwan. hc_cheng@vghtpe.gov.tw.|Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei 112, Taiwan. hc_cheng@vghtpe.gov.tw.
authors.forename: Yu-Chun
authors.initials: YC
authors.lastname: Chen
authors.affiliation: Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei 112, Taiwan. wchuang@vghtpe.gov.tw.|School of Medicine, National Yang-Ming University, Taipei 112, Taiwan. wchuang@vghtpe.gov.tw.
authors.forename: Wen-Cheng
authors.initials: WC
authors.lastname: Huang
authors.affiliation: Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei 112, Taiwan. hc_cheng@vghtpe.gov.tw.|Institute of Pharmacology, National Yang-Ming University, Taipei 112, Taiwan. hc_cheng@vghtpe.gov.tw.
authors.forename: Henrich
authors.initials: H
authors.lastname: Cheng
authors.affiliation: School of Medicine, National Yang-Ming University, Taipei 112, Taiwan. sslo@ymuh.ym.edu.tw.
authors.forename: Su-Shun
authors.initials: SS
authors.lastname: Lo
mesh_terms: D001924:Brain Concussion / Q000150:complications / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D016016:Proportional Hazards Models; D012307:Risk Factors; D020521:Stroke / Q000150:complications / Q000453:epidemiology*; D013624:Taiwan / Q000453:epidemiology
keywords: and traumatic brain injury (TBI); cohort; concussion; hemorrhagic stroke; ischemic stroke