Stroke incidence rate was 11 per 100,000 head and neck trauma patients under age 50 overall, and 48 per 100,000 in the 18 to 49 age range, the researchers reported here at the International Stroke Conference (ISC).
For comparison, those 4-week rates were well above the annual rate in the general population for children (2.5 per 100,000) and for young adults (on the order of 10 per 100,000), noted co-author Heather Fullerton, MD, MAS, also of UCSF.
Even relatively minor head or neck trauma has been well recognized as a trigger for blood vessel dissection leading to stroke, she acknowledged at an ISC press conference.
However, that risk hadn't been quantified, Fullerton pointed out. "And, really, that's the first step to figuring out primary stroke prevention in patients with trauma."
An arterial ischemic stroke was confirmed within 4 weeks of trauma in 145 of the 120,494 people younger than 50 years who had been treated in emergency trauma rooms for head or neck injury from 1997 through 2001, for a total rate of 0.011%.
Most strokes occurred in the first week.
Extrapolated to the 2 million patients seen for trauma in the U.S. each month, 214 of the young people among them would be expected to sustain an ischemic stroke per month.
The implication is that emergency physicians need to be alert to the risk and communicate it to patients who may think of stroke primarily as a problem of old age, commented Bruce Ovbiagele, MD, MSc, chief of neurology at the Medical University of South Carolina in Charleston.
"Information about warning signs for stroke in that period of time when they will be at especially high risk will be important to convey to them," he told MedPage Today at the press conference he chaired.
Fullerton agreed that patients need to be warned about the high risk of stroke before they're discharged home, perhaps giving them a card with the classic signs of stroke and urging them to call 911 at the first sign of symptoms.
Another possible implication is that anti-clotting medication could be given to patients diagnosed with a tear in the arteries leading to the brain at the time of trauma, the researchers suggested, although only 10% of those in the study had a diagnosis of cranio-cervical dissection recorded.
The next step will be a nested case-control study to detail stroke incidence after different types of trauma, such as car collisions and vertebral fractures, Fullerton noted.
The relative stroke risk was 2.8 in the 4 weeks after head or neck trauma versus other trauma-related emergency visits among 20- to 49-year-olds (95% CI 1.9-4.1), Christine Fox, MD, MAS, of the University of California San Francisco (UCSF) and colleagues found.
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