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Abstract
Objective: To explore whether traumatic brain injury (TBI) may be a risk factor for subsequent ischemic stroke.
Methods: Patients with any emergency department visit or hospitalization for TBI (exposed group) or non-TBI trauma (control) based on statewide emergency department and inpatient databases in California from 2005 to 2009 were included in a retrospective cohort. TBI was defined using the Centers for Disease Control definition. Our primary outcome was subsequent hospitalization for acute ischemic stroke. The association between TBI and stroke was estimated using Cox proportional hazards modeling adjusting for demographics, vascular risk factors, comorbidities, trauma severity, and trauma mechanism.
Results: The cohort included a total of 1,173,353 trauma subjects, 436,630 (37%) with TBI. The patients with TBI were slightly younger than the controls (mean age 49.2 vs 50.3 years), less likely to be female (46.8% vs 49.3%), and had a higher mean injury severity score (4.6 vs 4.1). Subsequent stroke was identified in 1.1% of the TBI group and 0.9% of the control group over a median follow-up period of 28 months (interquartile range 14–44). After adjustment, TBI was independently associated with subsequent ischemic stroke (hazard ratio 1.31, 95% confidence interval 1.25–1.36).
Conclusions: In this large cohort, TBI is associated with ischemic stroke, independent of other major predictors.
GLOSSARY
- CI=
- confidence interval;
- ED=
- emergency department;
- HCUP=
- Healthcare Cost and Utilization Project;
- HR=
- hazard ratio;
- ICD-9-CM=
- International Classification of Diseases, ninth revision, Clinical Modification;
- OR=
- odds ratio;
- SEDD=
- State Emergency Department Databases;
- SID=
- State Inpatient Databases;
- TBI=
- traumatic brain injury
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
- Received October 26, 2012.
- Accepted in final form March 11, 2013.
- © 2013 American Academy of Neurology
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