Traumatic brain injury may be an independent risk factor for stroke
Traumatic brain injury may be an independent risk factor for stroke
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DOI：
10.1212/wnl.0b013e318297eecf
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发表时间：
2013-07-02
期刊：
影响因子：
9.9
通讯作者：
Morgenstern, Lewis B.
中科院分区：
文献类型：
--
作者：
Burke, James F.;Stulc, Jessica L.;Morgenstern, Lewis B.
目的：探讨创伤性脑损伤（TBI）是否可能是随后缺血性stroke.Methods的危险因素：任何急诊科就诊或住院TBI（暴露组）或非TBI创伤（对照）的基础上全州急诊科和住院病人数据库在加州从2005年至2009年的患者被纳入一个回顾性队列。TBI的定义使用疾病控制中心的定义。我们的主要结局是随后因急性缺血性卒中住院。TBI和中风之间的关联估计使用考克斯比例风险模型调整人口统计学，血管危险因素，合并症，创伤严重程度，和创伤mechanism.Results：队列包括总共1,173,353创伤科目，436,630（37%）与TBI。TBI患者比对照组略年轻（平均年龄49.2岁vs 50.3岁），女性较少（46.8% vs 49.3%），平均损伤严重程度评分较高（4.6 vs 4.1）。在28个月的中位随访期内（四分位距14-44），TBI组和对照组分别有1.1%和0.9%的患者发生了后续卒中。调整后，TBI与随后的缺血性卒中独立相关（危险比1.31，95%置信区间1.25-1.36）。结论：在这个大的队列中，TBI与缺血性卒中相关，独立于其他主要预测因子。
Objective: To explore whether traumatic brain injury (TBI) may be a risk factor for subsequent ischemic stroke.Methods: Patients with any emergency department visit or hospitalization for TBI (exposed group) or non-TBI trauma (control) based on statewide emergency department and inpatient databases in California from 2005 to 2009 were included in a retrospective cohort. TBI was defined using the Centers for Disease Control definition. Our primary outcome was subsequent hospitalization for acute ischemic stroke. The association between TBI and stroke was estimated using Cox proportional hazards modeling adjusting for demographics, vascular risk factors, comorbidities, trauma severity, and trauma mechanism.Results: The cohort included a total of 1,173,353 trauma subjects, 436,630 (37%) with TBI. The patients with TBI were slightly younger than the controls (mean age 49.2 vs 50.3 years), less likely to be female (46.8% vs 49.3%), and had a higher mean injury severity score (4.6 vs 4.1). Subsequent stroke was identified in 1.1% of the TBI group and 0.9% of the control group over a median follow-up period of 28 months (interquartile range 14-44). After adjustment, TBI was independently associated with subsequent ischemic stroke (hazard ratio 1.31, 95% confidence interval 1.25-1.36).Conclusions: In this large cohort, TBI is associated with ischemic stroke, independent of other major predictors.