Identifying Risk of Stroke Following Traumatic Injury

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All patients had either a CT of the head or MRI of the brain, and 54% of patients had a vascular angiography as part of their trauma workup.
All patients had either a CT of the head or MRI of the brain, and 54% of patients had a vascular angiography as part of their trauma workup.

Children and adults <50 years of age who experience physical trauma have an increased risk for ischemic stroke for up to 2 weeks following the traumatic episode, according to findings from a retrospective, population-based study published in Neurology.

In this study, investigators sought to identify the incidence and risk level of patients who had an ischemic stroke during the first 4 weeks following physical trauma. Researchers evaluated data from patients enrolled in Kaiser Permanente Northern California, a healthcare delivery network comprising 21 community medical centers.

Of the 52 trauma-related strokes included in this analysis, 100% occurred within 4 weeks of trauma, represented by an incidence of 4.0 per 100,000 trauma cases (0.004%; 95% CI, 3.0-5.2). In 19 (37%) people, stroke occurred on the day the person experienced the traumatic episode.

In the case-control portion of this study, researchers compared the 52 patients with stroke with 156 control participants without stroke. Among patients experiencing trauma as a result of a vehicle collision that occurred while traveling at >35 miles/hour, there was a 21-fold increased risk for stroke (odds ratio [OR] 21.0; 95% CI, 1.8-248.1). An additional analysis adjusted for age, gender, race, and trauma severity found a significantly higher risk for stroke among patients who had head injury vs no head injury (OR 4.1; 95% CI, 1.1-14.9; P =.031) as well as for patients who had a neck injury vs no neck injury (OR 5.6; 95% CI, 1.03-30.9; P =.046).

One limitation of this study was the potential omission of stroke occurrences resulting from undocumented or misidentified clinical symptoms.

Although stroke risk in those who experience trauma appears to be elevated for up to 2 weeks after a traumatic event, the investigators show that the onset of stroke, “is frequently delayed, providing an opportunity for stroke prevention during this period.”

Reference

Fox CK, Hills NK, Vinson DR, et al. Population-based study of ischemic stroke risk after trauma in children and young adults. Neurology. 2017;89(23):2310-2316.

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