Research Reports - Risk and mortality of traumatic brain injury in stroke patients

J Head Trauma Rehabil. 2013 Nov 20

Chou YC, Yeh CC, Hu CJ, Meng NH, Chiu WT, Chou WH, Chen TL, Liao CC

OBJECTIVE:: 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.
METHODS:: 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.
RESULTS:: 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.
CONCLUSIONS:: 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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