J Head Trauma Rehabil. 2015 Mar-Apr;30
Albrecht JS(1), Liu X, Smith GS, Baumgarten M, Rattinger GB, Gambert SR,
Langenberg P, Zuckerman IH
OBJECTIVE: Following traumatic brain injury (TBI), older adults are at an
increased risk of hemorrhagic and thromboembolic events, but it is unclear
whether the increased risk continues after hospital discharge. We estimated
incidence rates of hemorrhagic and ischemic stroke following hospital discharge
for TBI among adults 65 years or older and compared them with pre-TBI rates.
PARTICIPANTS: A total of 16 936 Medicare beneficiaries 65 years or older with a
diagnosis of TBI in any position on an inpatient claim between June 1, 2006, and
December 31, 2009, who survived to hospital discharge.
DESIGN: Retrospective analysis of a random 5% sample of Medicare claims data.
MAIN MEASURES: Hemorrhagic stroke was defined as ICD-9 (International
Classification of Diseases, Ninth Revision) codes 430.xx-432.xx. Ischemic stroke
was defined as ICD-9 codes 433.xx-435.xx, 437.0x, and 437.1x.
RESULTS: There was a 6-fold increase in the rate of hemorrhagic stroke following
TBI compared with the pre-TBI period (adjusted rate ratio, 6.5; 95% confidence
interval, 5.3-7.8), controlling for age and sex. A smaller increase in the rate
of ischemic stroke was observed (adjusted rate ratio, 1.3; 95% CI, 1.2-1.4).
CONCLUSION: Future studies should investigate causes of increased stroke risk
post-TBI as well as effective treatment options to reduce stroke risk and improve
outcomes post-TBI among older adults.