Increased Risk of Stroke in Patients of Concussion: A Nationwide Cohort Study

Shih-Wei Liu, Liang-Chung Huang, Wu-Fu Chung, Hsuan-Kan Chang, Jau-Ching Wu, Li-Fu Chen, Yu-Chun Chen, Wen-Cheng Huang, Henrich Cheng and Su-Shun Lo
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Shih-Wei Liu: Department of Emergency Medicine, National Yang-Ming University Hospital, I-Lan 260, Taiwan
Liang-Chung Huang: Department of Emergency Medicine, National Yang-Ming University Hospital, I-Lan 260, Taiwan
Wu-Fu Chung: Department of Emergency Medicine, National Yang-Ming University Hospital, I-Lan 260, Taiwan
Hsuan-Kan Chang: Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei 112, Taiwan
Jau-Ching Wu: Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei 112, Taiwan
Li-Fu Chen: Department of Emergency Medicine, National Yang-Ming University Hospital, I-Lan 260, Taiwan
Yu-Chun Chen: School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
Wen-Cheng Huang: Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei 112, Taiwan
Henrich Cheng: Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei 112, Taiwan
Su-Shun Lo: School of Medicine, National Yang-Ming University, Taipei 112, Taiwan

IJERPH, 2017, vol. 14, issue 3, 1-12

Abstract: Long-term morbidities can develop after traumatic brain injury (TBI). Some studies have suggested that the risk of stroke is higher after TBI, but the association between concussion and stroke remains unclear. Using a national cohort, the authors analyzed the incidence of both hemorrhagic and ischemic strokes in patients with previous concussion. A representative cohort of approximately one million people was followed up for four years. Patients with new-onset concussion were identified ( n = 13,652) as the concussion group. Subsequently, the incidence rates of later stroke events in the concussion group were compared to a sex-, age- and propensity score–matched comparison group ( n = 13,652). The overall incidence rate of stroke in the concussion group was higher than that of the comparison group (9.63 versus 6.52 per 1000 person-years, p < 0.001). Significantly higher stroke risk was observed in the concussion group than in the comparison group (crude hazard ratio 1.48, p < 0.001; adjusted HR 1.65, p < 0.001). In the concussion group, the cumulative incidence rates of both ischemic stroke and hemorrhagic stroke were higher than those of the comparison group (8.9% vs. 5.8% and 2.7% vs. 1.6%, respectively, both p < 0.001). Concussion is an independent risk factor for both ischemic and hemorrhagic strokes. Prevention and monitoring strategies of stroke are therefore suggested for patients who have experienced concussion.

Keywords: concussion; hemorrhagic stroke; ischemic stroke; cohort; and traumatic brain injury (TBI) (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2017
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