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Published on: August 16, 2019
Population-based study of ischemic stroke risk after trauma in children and young adults
Christine K Fox1, Nancy K Hills2, David R Vinson2
1From the Departments of Neurology (C.K.F., A.L.N., H.J.F.), Pediatrics (C.K.F., A.L.N., H.J.F.), Epidemiology and Biostatistics (N.K.H.), and Surgery (R.A.D.), University of California, San Francisco; the Division of Research (D.R.V., S.S.), Kaiser Permanente Northern California, Oakland; and the Department of Emergency Medicine (D.R.V.), Kaiser Permanente Sacramento Medical Center, Sacramento, CA. Christine.Fox@ucsf.edu.
Insights
The risk of ischemic stroke is elevated for two weeks following trauma, with many cases occurring days after the initial injury. This highlights a critical window for potential stroke prevention strategies in trauma patients.
Area of Science:
- Neurology
- Trauma Surgery
- Public Health
Background:
- Traumatic injuries can lead to serious complications, including ischemic stroke.
- Understanding the incidence and timing of post-traumatic stroke is crucial for patient management.
Purpose of the Study:
- To determine the incidence, timing, and risk factors for ischemic stroke in young adults following trauma.
- To identify specific injury types associated with an increased risk of stroke.
Main Methods:
- Electronic identification of trauma patients under 50 years old within a large healthcare system.
- Confirmation of ischemic stroke cases within four weeks of trauma, with physician review and adjudication.
- Calculation of stroke incidence and odds ratios for various injury locations using logistic regression.
Main Results:
- A 4-week incidence of 4.0 per 100,000 trauma encounters for ischemic stroke was observed.
- Head and neck injuries were significantly associated with an increased stroke risk after adjusting for confounders.
- While 37% of strokes occurred on the day of trauma, all happened within 15 days, indicating a delayed onset possibility.
Conclusions:
- Ischemic stroke risk remains elevated for two weeks post-trauma, with a frequent delay in onset.
- Specific injuries, particularly to the head and neck, elevate stroke risk.
- The absence of detected vascular abnormalities in some cases suggests non-obstructive mechanisms may contribute to post-traumatic stroke.
Objective:
To quantify the incidence, timing, and risk of ischemic stroke after trauma in a population-based young cohort.
Methods:
We electronically identified trauma patients (<50 years old) from a population enrolled in a Northern Californian integrated health care delivery system (1997-2011). Within this cohort, we identified cases of arterial ischemic stroke within 4 weeks of trauma and 3 controls per case. A physician panel reviewed medical records, confirmed cases, and adjudicated whether the stroke was related to trauma. We calculated the 4-week stroke incidence and estimated stroke odds ratios (OR) by injury location using logistic regression.
Results:
From 1,308,009 trauma encounters, we confirmed 52 trauma-related ischemic strokes. The 4-week stroke incidence was 4.0 per 100,000 encounters (95% confidence interval [CI] 3.0-5.2). Trauma was multisystem in 26 (50%). In 19 (37%), the stroke occurred on the day of trauma, and all occurred within 15 days. In 7/28 cases with cerebrovascular angiography at the time of trauma, no abnormalities were detected. In unadjusted analyses, head, neck, chest, back, and abdominal injuries increased stroke risk. Only head (OR 4.1, CI 1.1-14.9) and neck (OR 5.6, CI 1.03-30.9) injuries remained associated with stroke after adjusting for demographics and trauma severity markers (multisystem trauma, motor vehicle collision, arrival by ambulance, intubation).
Conclusions:
Stroke risk is elevated for 2 weeks after trauma. Onset is frequently delayed, providing an opportunity for stroke prevention during this period. However, in one-quarter of stroke cases with cerebrovascular angiography at the time of trauma, no vascular abnormality was detected.
