Acute Ischemic Stroke After Moderate to Severe Traumatic Brain Injury: Incidence and Impact on Outcome

Background and Purpose—Traumatic brain injury (TBI) leads to nearly 300 000 annual US hospitalizations and increased lifetime risk of acute ischemic stroke (AIS). Occurrence of AIS immediately after TBI has not been well characterized. We evaluated AIS acutely after TBI and its impact on outcome. Methods—A prospective database of moderate to severe TBI survivors, admitted to inpatient rehabilitation at 22 Traumatic Brain Injury Model Systems centers and their referring acute-care hospitals, was analyzed. Outcome measures were AIS incidence, duration of posttraumatic amnesia, Functional Independence Measure, and Disability Rating Scale, at rehabilitation discharge. Results—Between October 1, 2007, and March 31, 2015, 6488 patients with TBI were enrolled in the Traumatic Brain Injury Model Systems National Database. One hundred and fifty-nine (2.5%) patients had a concurrent AIS, and among these, median age was 40 years. AIS was associated with intracranial mass effect and carotid or vertebral artery dissection. High-velocity events more commonly caused TBI with dissection. AIS predicted poorer outcome by all measures, accounting for a 13.3-point reduction in Functional Independence Measure total score (95% confidence interval, −16.8 to −9.7; P<0.001), a 1.9-point increase in Disability Rating Scale (95% confidence interval, 1.3–2.5; P<0.001), and an 18.3-day increase in posttraumatic amnesia duration (95% confidence interval, 13.1–23.4; P<0.001). Conclusions—Ischemic stroke is observed acutely in 2.5% of moderate to severe TBI survivors and predicts worse functional and cognitive outcome. Half of TBI patients with AIS were aged ≤40 years, and AIS patients more often had cervical dissection. Vigilance for AIS is warranted acutely after TBI, particularly after high-velocity events

Injuries and post-traumatic stress following historic tornados: Alabama, April 2011.

OBJECTIVES: We analyzed tornado-related injuries seen at hospitals and risk factors for tornado injury, and screened for post-traumatic stress following a statewide tornado-emergency in Alabama in April 2011. METHODS: We conducted a chart abstraction of 1,398 patients at 39 hospitals, mapped injured cases, and conducted a case-control telephone survey of 98 injured cases along with 200 uninjured controls. RESULTS: Most (n = 1,111, 79.5%) injuries treated were non-life threatening (Injury Severity Score ≤ 15). Severe injuries often affected head (72.9%) and chest regions (86.4%). Mobile home residents showed the highest odds of injury (OR, 6.98; 95% CI: 2.10-23.20). No severe injuries occurred in tornado shelters. Within permanent homes, the odds of injury were decreased for basements (OR, 0.13; 95% CI: 0.04-0.40), bathrooms (OR, 0.22; 95% CI: 0.06-0.78), hallways (OR, 0.31; 95% CI: 0.11-0.90) and closets (OR, 0.25; 95% CI: 0.07-0.80). Exposure to warnings via the Internet (aOR, 0.20; 95% CI: 0.09-0.49), television (aOR, 0.45; 95% CI: 0.24-0.83), and sirens (aOR, 0.50; 95% CI: 0.30-0.85) decreased the odds of injury, and residents frequently exposed to tornado sirens had lower odds of injury. The prevalence of PTSD in respondents was 22.1% and screening positive for PTSD symptoms was associated with tornado-related loss events. CONCLUSIONS: Primary prevention, particularly improved shelter access, and media warnings, seem essential to prevent severe tornado-injury. Small rooms such as bathrooms may provide some protection within permanent homes when no underground shelter is available

Odds of injury associated with respondent's location during the time of tornado impact among surveyed cases (N = 73) and controls (N = 183) with non-missing distance to the closest tornado track.

<p>^a Controlled for the distance to the closest tornado track at the time of tornado impact, age, sex and race.</p><p> = 56 cases, N = 135 controls).^b Calculations based on injuries that occurred in permanent residences (N</p><p>“Other” includes stone, stucco, cinder block, and steel.^c</p>d<p>Includes firefighter helmet, bicycle helmet, and motorcycle helmet.</p

Geographic Information System (GIS) mapping of locations at the time of the tornado for 183 uninjured interviewed controls and 284 injured cases (including 73 interviewed cases and 211 non-interviewed patients with geocodable information in their hospital chart).

<p>A layer indicating the tornado paths was added. Most of the mapped cases (83.0%) and controls (83.3%) were closest to a violent EF 4–5 tornado path. EF tornado rating scale estimates the strongest wind gusts that occur 10 meters above the ground: EF-0 (65–85 mph [105–137 km/h]), EF-1 (86–110 mph [138–177 km/h]), EF-2 (111–135 mph [178–217 km/h]), EF-3 (136–165 mph [218–266 km/h]), EF-4 (166–200 mph [267–322 km/h]), and EF-5 (>200 mph [>322 km/h]).<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0083038#pone.0083038-Wind1" target="_blank">[1]</a></p