Abstract Details

Title Comorbidities Arising After Traumatic Brain Injury Increase the Risk of Ischemic Stroke

Topic Neuro Trauma, Critical Care, and Sports Neurology

Presentation(s) Neurocritical Care Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 043

Objective

The purpose of our study is to investigate the association between comorbidities developing after traumatic brain injury (TBI) and risk of ischemic stroke (IS)

Background Much research has been conducted on the risk of IS following TBI and the effect of pre-existing comorbidities on such risk; however, little is known about the possible links between post-TBI comorbidities and incidence of IS post-injury

Design/Methods Retrospective cohort study of 4,442 mild (mTBI) and 4,442 moderate/severe (msTBI) patients aged 18 or older matched to non-head ortho trauma controls. Medical and psychiatric comorbidities were defined by ICD-9/10 codes. Patients with IS and comorbidities prior to trauma were excluded. Cox proportional hazards models with time-varying covariates were used to determine the association between TBI and IS and post-TBI comorbidities after multivariable adjustment.

Results

TBI patients were 52% male (median age of 46, IQR= 29-57 years) at enrollment with a median follow-up time of 5 years and well-matched to controls. During follow-up, IS developed more in msTBI group (2.9%), compared to mTBI (1.7%) and controls (1.9%) (p<0.001). After adjustment, only msTBI was independently associated with subsequent IS (HR 1.3, 95%CI 0.9-1.8 for mTBI and HR 2.2, 95%CI 1.6-3.1 for msTBI). On univariable analysis, hypertension, hyperlipidemia, diabetes, peripheral vascular disease, atrial fibrillation, coronary artery disease, TBI severity, headache, smoking, age, and female gender were associated with IS (P<0.05). On multivariable analysis, hypertension (HR 2.4, 95% CI 1.6-3.6), alcoholism (HR 2.7, 95% CI 1.4-5.3), headache (HR 1.5, 95% CI 1.0-2.2), smoking (HR 2.2, 95% CI 1.4-3.5), increased age, and female gender (HR 0.7 95% CI 0.5-0.9) were independent predictors of IS post-injury.

Conclusions Comorbidities developing after TBI are independent predictors of increasing risk of IS after injury. Future prospective studies are needed to better describe the burden of these comorbidities and to define role of medical surveillance in identifying patients at risk.

Authors/Disclosures
PRESENTER	No disclosure on file
Farid Radmanesh, MD, MPH	Dr. Radmanesh has nothing to disclose.
Taha Yahya	Taha Yahya has nothing to disclose.
	No disclosure on file
	No disclosure on file
Hanife Saglam, MD (West Virginia University)	Dr. Saglam has nothing to disclose.
Hadi Abou-El-Hassan, MD	Dr. Abou-El-Hassan has nothing to disclose.
Samuel Snider, MD (Massachusetts General Hospital, Brigham, Harvard)	Dr. Snider has nothing to disclose.
Saef Izzy, MD, FAAN (Brigham and Women'S Hospital, Harvard Medical School)	The institution of Dr. Izzy has received research support from NINDS. The institution of Dr. Izzy has received research support from The Gillian Reny Stepping Strong Center for Trauma Innovation. Dr. Izzy has received publishing royalties from a publication relating to health care.
Steven K. Feske, MD (Boston Medical Center, Neurology Department)	Dr. Feske has received publishing royalties from a publication relating to health care.

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