Article

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.

Langue : ANGLAIS