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Volume 14
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10.3390/ijerph14030230
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Article

Increased Risk of Stroke in Patients of Concussion: A Nationwide Cohort Study

by
Shih-Wei Liu
1,
Liang-Chung Huang
1,
Wu-Fu Chung
1,
Hsuan-Kan Chang
2,
Jau-Ching Wu
2,3,*,
Li-Fu Chen
1,3,*,
Yu-Chun Chen
3,4,5,
Wen-Cheng Huang
2,3,
Henrich Cheng
2,6 and
Su-Shun Lo
3
1
Department of Emergency Medicine, National Yang-Ming University Hospital, I-Lan 260, Taiwan
2
Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei 112, Taiwan
3
School of Medicine, National Yang-Ming University, Taipei 112, Taiwan
4
Department of Medical Research and Education, National Yang-Ming University Hospital, I-Lan 260, Taiwan
5
Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei 112, Taiwan
6
Institute of Pharmacology, National Yang-Ming University, Taipei 112, Taiwan
*
Authors to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2017, 14(3), 230; https://doi.org/10.3390/ijerph14030230
Submission received: 2 January 2017 / Revised: 14 February 2017 / Accepted: 17 February 2017 / Published: 25 February 2017
(This article belongs to the Section Global Health)
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Abstract

Long-term morbidities can develop after traumatic brain injury (TBI). Some studies have suggested that the risk of stroke is higher after TBI, but the association between concussion and stroke remains unclear. Using a national cohort, the authors analyzed the incidence of both hemorrhagic and ischemic strokes in patients with previous concussion. A representative cohort of approximately one million people was followed up for four years. Patients with new-onset concussion were identified (n = 13,652) as the concussion group. Subsequently, the incidence rates of later stroke events in the concussion group were compared to a sex-, age- and propensity score–matched comparison group (n = 13,652). The overall incidence rate of stroke in the concussion group was higher than that of the comparison group (9.63 versus 6.52 per 1000 person-years, p < 0.001). Significantly higher stroke risk was observed in the concussion group than in the comparison group (crude hazard ratio 1.48, p < 0.001; adjusted HR 1.65, p < 0.001). In the concussion group, the cumulative incidence rates of both ischemic stroke and hemorrhagic stroke were higher than those of the comparison group (8.9% vs. 5.8% and 2.7% vs. 1.6%, respectively, both p < 0.001). Concussion is an independent risk factor for both ischemic and hemorrhagic strokes. Prevention and monitoring strategies of stroke are therefore suggested for patients who have experienced concussion.
Keywords: concussion; hemorrhagic stroke; ischemic stroke; cohort; and traumatic brain injury (TBI) concussion; hemorrhagic stroke; ischemic stroke; cohort; and traumatic brain injury (TBI)

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MDPI and ACS Style

Liu, S.-W.; Huang, L.-C.; Chung, W.-F.; Chang, H.-K.; Wu, J.-C.; Chen, L.-F.; Chen, Y.-C.; Huang, W.-C.; Cheng, H.; Lo, S.-S. Increased Risk of Stroke in Patients of Concussion: A Nationwide Cohort Study. Int. J. Environ. Res. Public Health 2017, 14, 230. https://doi.org/10.3390/ijerph14030230

AMA Style

Liu S-W, Huang L-C, Chung W-F, Chang H-K, Wu J-C, Chen L-F, Chen Y-C, Huang W-C, Cheng H, Lo S-S. Increased Risk of Stroke in Patients of Concussion: A Nationwide Cohort Study. International Journal of Environmental Research and Public Health. 2017; 14(3):230. https://doi.org/10.3390/ijerph14030230

Chicago/Turabian Style

Liu, Shih-Wei, Liang-Chung Huang, Wu-Fu Chung, Hsuan-Kan Chang, Jau-Ching Wu, Li-Fu Chen, Yu-Chun Chen, Wen-Cheng Huang, Henrich Cheng, and Su-Shun Lo. 2017. "Increased Risk of Stroke in Patients of Concussion: A Nationwide Cohort Study" International Journal of Environmental Research and Public Health 14, no. 3: 230. https://doi.org/10.3390/ijerph14030230

APA Style

Liu, S.-W., Huang, L.-C., Chung, W.-F., Chang, H.-K., Wu, J.-C., Chen, L.-F., Chen, Y.-C., Huang, W.-C., Cheng, H., & Lo, S.-S. (2017). Increased Risk of Stroke in Patients of Concussion: A Nationwide Cohort Study. International Journal of Environmental Research and Public Health, 14(3), 230. https://doi.org/10.3390/ijerph14030230

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