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Abstract WP201: Ischemic Stroke Risk After Traumatic Head or Neck Injury


 Introduction:
 Traumatic arterial dissection is an important cause of ischemic stroke in the young, but data are needed to guide selection of trauma patients to screen with cerebrovascular imaging.
 
 
 Hypothesis:
 Ischemic stroke risk after head or neck trauma can be stratified by demographic and clinical factors.
 
 
 Methods:
 In a Northern California integrated health care system, we identified people (age < 50) with head or neck trauma from 1997-2011 by ICD-9 searches (800-806, 850-854; 873, 874, 900, 920, 925, 950-953; excluding fifth digit codes for injury below the neck). Ischemic strokes within 4 weeks were identified by ICD-9 (433-438) and confirmed by chart review. We randomly selected 3 controls per case from the remaining cohort. Characteristics potentially associated with stroke were abstracted and examined using logistic regression. Stroke incidence rates were calculated using survival analysis, right censoring at death or 4 weeks post-trauma.
 
 
 Results:
 From 120,494 trauma encounters in the emergency department or for hospital admission, we confirmed 45 ischemic strokes related to head or neck trauma. The 4-week stroke incidence was 0.04% (95% CI 0.03-0.05%) (Figure: Kaplan-Meier stroke failure function and 95% CI). The majority of ischemic strokes occurred early after trauma, with 40% on the day of the trauma. Stroke risk was not associated with gender or race/ethnicity, but was age-related: for each decade older, stroke risk increased 70% (OR 1.7, 95% CI 1.4-2.2%, P<0.001). Any neck trauma (OR 14, 95% CI 4.9-42, P<0.0001 compared to those with isolated head trauma) and altered mental status on exam (OR 18, 95% CI 6.7-46, P < 0.0001) were also associated with increased risk of ischemic stroke. Neck trauma and altered mental status remained independently associated with ischemic stroke even after age-adjustment.
 
 
 Conclusions:
 Trauma patients with neck injuries or altered mental status have elevated stroke risk and should be considered for cerebrovascular imaging.
 
 
 
