Department of Physical Medicine and Rehabilitation (Drs Esterov and Brown) and Mayo Medical Library (Ms Kinzelman Vesely), Mayo Clinic, Rochester, Minnesota; and Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota (Drs Sperl and Hines).
J Head Trauma Rehabil. 2023;38(1):E44-E55. doi: 10.1097/HTR.0000000000000785. Epub 2022 May 26.
To determine whether exposure to traumatic brain injury (TBI) is associated with increased risk of stroke in adults compared with referents not exposed to TBI, and to understand whether an association exists throughout the spectrum of injury severity, whether it differs between the acute and chronic phases after TBI, and whether the association is greater with hemorrhagic compared with ischemic stroke after TBI.
A database search was conducted on January 22, 2021. Searches were run in MEDLINE (1946 to present), Embase (1988 to present), Evidence-Based Medicine Reviews (various dates), Scopus (1970 to present), and Web of Science (1975 to present).
Observational studies that quantified the association of stroke after TBI compared with referents without TBI were included. Three coauthors independently reviewed titles and abstracts to determine study eligibility. Study characteristics were extracted independently by 2 coauthors who followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and study quality was assessed independently by 2 coauthors who used the Newcastle-Ottawa Scale. Random-effects meta-analyses were performed.
The primary exposure was TBI of any severity, and the primary outcome was stroke of any kind. Subgroup analysis was performed to assess heterogeneity associated with severity of TBI, type of stroke, and time from TBI to stroke.
A total of 64 full-text articles were reviewed, and data were extracted from 8 cohort studies (N = 619 992 individuals exposed to TBI along with nonexposed referents). A significant overall association was found with TBI and stroke (hazard ratio, 2.06; 95% CI, 1.28-3.32). Significant subgroup differences were found with a smaller risk of ischemic stroke compared with stroke of all types (P < .001, I² = 93.9%).
TBI, regardless of injury severity, was associated with a higher risk of stroke. To improve secondary stroke prevention strategies, future studies should classify TBI severity and type of stroke more precisely and determine long-term risk.
确定与未暴露于创伤性脑损伤（TBI）的对照者相比，TBI 暴露是否会增加成年人中风的风险，并了解这种关联是否存在于整个损伤严重程度谱中，是否存在于 TBI 后的急性和慢性阶段之间，以及与 TBI 后出血性中风相比，这种关联是否更大。
于 2021 年 1 月 22 日进行数据库检索。在 MEDLINE（1946 年至今）、Embase（1988 年至今）、循证医学评论（各种日期）、Scopus（1970 年至今）和 Web of Science（1975 年至今）中进行了检索。
纳入了定量评估 TBI 后中风与无 TBI 对照者之间关联的观察性研究。三位合著者独立审查标题和摘要以确定研究的资格。两位合著者独立提取研究特征，遵循系统评价和荟萃分析的首选报告项目指南，两位合著者独立使用纽卡斯尔-渥太华量表评估研究质量。进行了随机效应荟萃分析。
主要暴露是任何严重程度的 TBI，主要结局是任何类型的中风。进行了亚组分析，以评估与 TBI 严重程度、中风类型和 TBI 到中风的时间相关的异质性。
共审查了 64 篇全文文章，并从 8 项队列研究中提取了数据（N=619992 名暴露于 TBI 以及未暴露于 TBI 的对照者）。发现 TBI 与中风之间存在显著的总体关联（危险比，2.06；95%CI，1.28-3.32）。发现与所有类型中风相比，缺血性中风的风险较小，存在显著的亚组差异（P<0.001，I²=93.9%）。
无论损伤严重程度如何，TBI 都与中风风险增加相关。为了改进二级中风预防策略，未来的研究应更精确地对 TBI 严重程度和中风类型进行分类，并确定长期风险。
