TY - JOUR
T1 - Long-Term Risk of Stroke after Traumatic Brain Injury
T2 - A Population-Based Medical Record Review Study
AU - Sperl, Michael A.
AU - Esterov, Dmitry
AU - Ransom, Jeanine E.
AU - Mielke, Michelle M.
AU - Witkowski, Julie E.
AU - Brown, Allen W.
N1 - Publisher Copyright:
© 2022 S. Karger AG, Basel.
PY - 2022
Y1 - 2022
N2 - OBJECTIVE: To reliably inform secondary prevention strategies and reduce morbidity and mortality after traumatic brain injury (TBI), we sought to understand the long-term risk of stroke after TBI in patients aged 40 years and older in comparison to age- and sex-matched referents from a population-based cohort. MATERIALS AND METHODS: TBI cases in Olmsted County, Minnesota from January 1, 1985, to December 31, 1999, were confirmed by manual review, classified by injury severity and mechanism, and nonhead trauma was quantified. Each TBI case was matched to 2 sex- and age-matched population-based referents without TBI and with similar severity nonhead trauma. Records of cases and referents were manually abstracted to confirm stroke diagnosis. Stroke events during initial hospitalization for TBI were excluded. RESULTS: In total, 1,410 TBI cases were confirmed, 61% classified as possible TBI (least severe, consistent with concussive), with the most common mechanism being falls. There were 162 stroke events among those with TBI (11.5%) and 269 among referents (9.5%). Median time to stroke from the index date for those with TBI was 10.2 years (Q1-Q3 5.2-17.8), and for referents 12.1 years (Q1-Q3 6.2-17.3), p = 0.215. All-severity TBI was associated with increased risk of stroke (HR: 1.32, 95% CI: 1.06-1.63, p = 0.011), but only definite TBI (consistent with moderate-severe) was associated with significant risk (HR: 2.20, 95% CI: 1.04-4.64, p = 0.038) when stratified by severity. DISCUSSION/CONCLUSION: By confirming TBI cases, stroke diagnoses, and injury severity classification using manual review with levels of accuracy not previously reported, these results indicate moderate-severe TBI increases long-term risk for stroke. These findings confirm the need to regularly assess long-term vascular risk after TBI to implement disease prevention strategies.
AB - OBJECTIVE: To reliably inform secondary prevention strategies and reduce morbidity and mortality after traumatic brain injury (TBI), we sought to understand the long-term risk of stroke after TBI in patients aged 40 years and older in comparison to age- and sex-matched referents from a population-based cohort. MATERIALS AND METHODS: TBI cases in Olmsted County, Minnesota from January 1, 1985, to December 31, 1999, were confirmed by manual review, classified by injury severity and mechanism, and nonhead trauma was quantified. Each TBI case was matched to 2 sex- and age-matched population-based referents without TBI and with similar severity nonhead trauma. Records of cases and referents were manually abstracted to confirm stroke diagnosis. Stroke events during initial hospitalization for TBI were excluded. RESULTS: In total, 1,410 TBI cases were confirmed, 61% classified as possible TBI (least severe, consistent with concussive), with the most common mechanism being falls. There were 162 stroke events among those with TBI (11.5%) and 269 among referents (9.5%). Median time to stroke from the index date for those with TBI was 10.2 years (Q1-Q3 5.2-17.8), and for referents 12.1 years (Q1-Q3 6.2-17.3), p = 0.215. All-severity TBI was associated with increased risk of stroke (HR: 1.32, 95% CI: 1.06-1.63, p = 0.011), but only definite TBI (consistent with moderate-severe) was associated with significant risk (HR: 2.20, 95% CI: 1.04-4.64, p = 0.038) when stratified by severity. DISCUSSION/CONCLUSION: By confirming TBI cases, stroke diagnoses, and injury severity classification using manual review with levels of accuracy not previously reported, these results indicate moderate-severe TBI increases long-term risk for stroke. These findings confirm the need to regularly assess long-term vascular risk after TBI to implement disease prevention strategies.
KW - Epidemiology
KW - Stroke
KW - Traumatic brain injury
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U2 - 10.1159/000525111
DO - 10.1159/000525111
M3 - Article
C2 - 35613548
AN - SCOPUS:85137154542
SN - 0251-5350
VL - 56
SP - 283
EP - 290
JO - Neuroepidemiology
JF - Neuroepidemiology
IS - 4
ER -