Stroke after trauma in children and young adults: Some opportunity for primary prevention

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Stroke is a feared complication of major trauma.1 Multiple guidelines exist regarding screening for blunt cerebrovascular injury (BCVI)2–5 though reliable estimates of the incidence of stroke after trauma are limited. In this issue of Neurology®, Fox et al.6 utilize a retrospective cohort within the Kaiser Permanente of Northern California (KPNC) system to assess incidence, timing, and risk factors for stroke after trauma in children and adults <50 years of age over a 15-year period (1997–2011). From 1.3 million trauma admissions or emergency department encounters, the authors identified patients with an ICD-9 code for stroke within 4 weeks of trauma. Two neurologists reviewed medical records, confirmed cases, and decided whether the stroke was trauma-related; a third neurologist adjudicated disagreements. The authors confirmed 153 ischemic strokes within 4 weeks of a trauma encounter and of these, 52 strokes seemed trauma-related and were used to calculate stroke incidence. A nested case-control study was performed to determine differences between trauma patients with and without stroke; 3 stroke-free controls per stroke case were identified from the trauma cohort. Markers of trauma severity were adjusted for, including multisystem trauma, motor vehicle collision, arrival by ambulance, and intubation.

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