Abstract

Objective: To investigate whether patients with traumatic brain injury (TBI) have an increased risk of stroke or poststroke mortality. Participants and 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 casecontrol 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.

Original languageEnglish
Pages (from-to)163-172
Number of pages10
JournalMayo Clinic Proceedings
Volume89
Issue number2
DOIs
Publication statusPublished - 2014

Fingerprint

Stroke
Mortality
Traumatic Brain Injury
Odds Ratio
Skull Fractures
Intracranial Hemorrhages
National Health Programs
Emergency Medical Services
Vulnerable Populations
Health Expenditures
Hospital Mortality
Taiwan
Research
Hospitalization
Cohort Studies
Retrospective Studies
Age Groups
Databases

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Stroke risk and outcomes in patients with traumatic brain injury : 2 Nationwide studies. / Liao, Chien Chang; Chou, Yi Chun; Yeh, Chun Chieh; Hu, Chaur Jong; Chiu, Wen Ta; Chen, Ta Liang.

In: Mayo Clinic Proceedings, Vol. 89, No. 2, 2014, p. 163-172.

Research output: Contribution to journalArticle

@article{460dbf25141a4b7b87c522f4250a9124,
title = "Stroke risk and outcomes in patients with traumatic brain injury: 2 Nationwide studies",
abstract = "Objective: To investigate whether patients with traumatic brain injury (TBI) have an increased risk of stroke or poststroke mortality. Participants and 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 casecontrol 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.",
author = "Liao, {Chien Chang} and Chou, {Yi Chun} and Yeh, {Chun Chieh} and Hu, {Chaur Jong} and Chiu, {Wen Ta} and Chen, {Ta Liang}",
year = "2014",
doi = "10.1016/j.mayocp.2013.09.019",
language = "English",
volume = "89",
pages = "163--172",
journal = "Mayo Clinic Proceedings",
issn = "0025-6196",
publisher = "Elsevier Science",
number = "2",

}

TY - JOUR

T1 - Stroke risk and outcomes in patients with traumatic brain injury

T2 - 2 Nationwide studies

AU - Liao, Chien Chang

AU - Chou, Yi Chun

AU - Yeh, Chun Chieh

AU - Hu, Chaur Jong

AU - Chiu, Wen Ta

AU - Chen, Ta Liang

PY - 2014

Y1 - 2014

N2 - Objective: To investigate whether patients with traumatic brain injury (TBI) have an increased risk of stroke or poststroke mortality. Participants and 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 casecontrol 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.

AB - Objective: To investigate whether patients with traumatic brain injury (TBI) have an increased risk of stroke or poststroke mortality. Participants and 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 casecontrol 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.

UR - http://www.scopus.com/inward/record.url?scp=84897575041&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84897575041&partnerID=8YFLogxK

U2 - 10.1016/j.mayocp.2013.09.019

DO - 10.1016/j.mayocp.2013.09.019

M3 - Article

C2 - 24485130

AN - SCOPUS:84897575041

VL - 89

SP - 163

EP - 172

JO - Mayo Clinic Proceedings

JF - Mayo Clinic Proceedings

SN - 0025-6196

IS - 2

ER -