Abstract

Patients with stroke had higher incidence of falls and hip fractures. However, the risk of traumatic brain injury (TBI) and post-TBI mortality in patients with stroke was not well defined. Our study is to investigate the risk of TBI and post-TBI mortality in patients with stroke.

Using reimbursement claims from Taiwan's National Health Insurance Research Database, we conducted a retrospective cohort study of 7622 patients with stroke and 30 488 participants without stroke aged 20 years and older as reference group. Data were collected on newly developed TBI after stroke with 5 to 8 years' follow-up during 2000 to 2008. Another nested cohort study including 7034 hospitalized patients with TBI was also conducted to analyze the contribution of stroke to post-TBI in-hospital mortality.

Compared with the nonstroke cohort, the adjusted hazard ratio of TBI risk among patients with stroke was 2.80 (95% confidence interval = 2.58-3.04) during the follow-up period. Patients with stroke had higher mortality after TBI than those without stroke (10.2% vs 3.2%, P <.0001) with an adjusted relative risk (RR) of 1.46 (95% confidence interval = 1.15-1.84). Recurrent stroke (RR = 1.60), hemorrhagic stroke (RR = 1.68), high medical expenditure for stroke (RR = 1.80), epilepsy (RR = 1.79), neurosurgery (RR = 1.94), and hip fracture (RR = 2.11) were all associated with significantly higher post-TBI mortality among patients with stroke.

Patients with stroke have an increased risk of TBI and in-hospital mortality after TBI. Various characteristics of stroke severity were all associated with higher post-TBI mortality. Special attention is needed to prevent TBI among these populations.

Original languageEnglish
Pages (from-to)514-521
Number of pages8
JournalJournal of Head Trauma Rehabilitation
Volume29
Issue number6
DOIs
Publication statusPublished - Dec 10 2014

Fingerprint

Cohort Studies
Stroke
Mortality
Traumatic Brain Injury
Hip Fractures
Hospital Mortality
Confidence Intervals
National Health Programs
Neurosurgery
Health Expenditures
Taiwan
Epilepsy
Retrospective Studies
Databases

Keywords

  • Key words: mortality
  • Stroke
  • Traumatic brain injury

ASJC Scopus subject areas

  • Rehabilitation
  • Clinical Neurology
  • Physical Therapy, Sports Therapy and Rehabilitation

Cite this

Risk and mortality of traumatic brain injury in stroke patients : Two nationwide cohort studies. / Chou, Yi Chun; Yeh, Chun Chieh; Hu, Chaur-Jong; Meng, Nai Hsin; Chiu, Wen-Ta; Chou, Wan Hsin; Chen, Ta-Liang; Liao, Chien-Chang.

In: Journal of Head Trauma Rehabilitation, Vol. 29, No. 6, 10.12.2014, p. 514-521.

Research output: Contribution to journalArticle

Chou, Yi Chun ; Yeh, Chun Chieh ; Hu, Chaur-Jong ; Meng, Nai Hsin ; Chiu, Wen-Ta ; Chou, Wan Hsin ; Chen, Ta-Liang ; Liao, Chien-Chang. / Risk and mortality of traumatic brain injury in stroke patients : Two nationwide cohort studies. In: Journal of Head Trauma Rehabilitation. 2014 ; Vol. 29, No. 6. pp. 514-521.
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AU - Chiu, Wen-Ta

AU - Chou, Wan Hsin

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AB - Patients with stroke had higher incidence of falls and hip fractures. However, the risk of traumatic brain injury (TBI) and post-TBI mortality in patients with stroke was not well defined. Our study is to investigate the risk of TBI and post-TBI mortality in patients with stroke.Using reimbursement claims from Taiwan's National Health Insurance Research Database, we conducted a retrospective cohort study of 7622 patients with stroke and 30 488 participants without stroke aged 20 years and older as reference group. Data were collected on newly developed TBI after stroke with 5 to 8 years' follow-up during 2000 to 2008. Another nested cohort study including 7034 hospitalized patients with TBI was also conducted to analyze the contribution of stroke to post-TBI in-hospital mortality.Compared with the nonstroke cohort, the adjusted hazard ratio of TBI risk among patients with stroke was 2.80 (95% confidence interval = 2.58-3.04) during the follow-up period. Patients with stroke had higher mortality after TBI than those without stroke (10.2% vs 3.2%, P <.0001) with an adjusted relative risk (RR) of 1.46 (95% confidence interval = 1.15-1.84). Recurrent stroke (RR = 1.60), hemorrhagic stroke (RR = 1.68), high medical expenditure for stroke (RR = 1.80), epilepsy (RR = 1.79), neurosurgery (RR = 1.94), and hip fracture (RR = 2.11) were all associated with significantly higher post-TBI mortality among patients with stroke.Patients with stroke have an increased risk of TBI and in-hospital mortality after TBI. Various characteristics of stroke severity were all associated with higher post-TBI mortality. Special attention is needed to prevent TBI among these populations.

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