Cerebrovascular accident, commonly known as stroke, causes an estimated 2.4% of all self-reported disabilities in the United States and can result in deficits in cognition, mental health, and sensorimotor function. Additionally, motor instability, weakness, and sensory loss following a stroke leaves individuals vulnerable to orthopedic injuries and traumatic brain injuries (TBI). Furthermore, neuroinflammation caused by previous stroke may worsen the burden of neuroinflammation during TBI, and anticoagulant medications (which are commonly prescribed after stroke) are associated with poor acute outcomes in patients admitted with TBI.
There is minimal research on the impact of a preexisting stroke on neurological trauma outcomes, despite the increased risk of trauma from falls. To better understand the interactive effects of stroke and TBI, a team of researchers conducted a study assessing mortality, treatment, and functional status among those with a history of both stroke and TBI. The study included data from 46,592 patients admitted to the hospital between 1992 and 2019 across four groups: those who experienced an orthopedic injury with and without stroke, and those who experienced a TBI with and without stroke.
The researchers found that:
- Patients who experienced a stroke prior to TBI consistently experienced the longest average hospital stays and had significantly longer stays in the ICU.
- Compared to injury patients who did not experience a stroke, those who did experience a stroke showed significantly worse locomotion and were less able to feed themselves independently.
- Both groups of stroke patients were less likely to be discharged from the hospital to home (30.7%) as compared to non-stroke patients (40.6%). Stroke patients were most frequently discharged to a skilled nursing facility.
While these results do not suggest that the compounding neuroinflammatory effects of stroke and TBI affect patient outcomes, a history of stroke generally had a detrimental effect on patients’ functional outcomes and return to home. It is important for stroke patients and their care providers to be vigilant in fall prevention and remain aware of the greater risks associated with traumatic injuries.
Vervoordt S, Hamze M, Dell K, et al. Effects of preexisting stroke on acute hospital outcomes for older adults admitted with neurotrauma and orthopedic injury. Brain Injury. (August 2022).