Decreased Risk of Stroke in Patients with Traumatic Brain Injury Receiving Acupuncture Treatment: A Population-Based Retrospective Cohort Study

Chun-Chuan Shih,Yi-Ting Hsu,Wen-Ta Chiu,Hsin-Long Lane,Chien-Chang Liao,Chun-Chieh Yeh,Chin-Chuan Tsai,Hwang-Huei Wang,Ta-Liang Chen,Fung-Chang Sung,Yih-Giun Cherng,Cesar V Borlongan

doi:10.1371/journal.pone.0089208

Abstract

BackgroundPatients with traumatic brain injury (TBI) face increased risk of stroke. Whether acupuncture can help to protect TBI patients from stroke has not previously been studied.MethodsTaiwan's National Health Insurance Research Database was used to conduct a retrospective cohort study of 7409 TBI patients receiving acupuncture treatment and 29,636 propensity-score-matched TBI patients without acupuncture treatment in 2000–2008 as controls. Both TBI cohorts were followed until the end of 2010 and adjusted for immortal time to measure the incidence and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs) of new-onset stroke in the multivariable Cox proportional hazard models.ResultsTBI patients with acupuncture treatment (4.9 per 1000 person-years) had a lower incidence of stroke compared with those without acupuncture treatment (7.5 per 1000 person-years), with a HR of 0.59 (95% CI = 0.50–0.69) after adjustment for sociodemographics, coexisting medical conditions and medications. The association between acupuncture treatment and stroke risk was investigated by sex and age group (20–44, 45–64, and ≥65 years). The probability curve with log-rank test showed that TBI patients receiving acupuncture treatment had a lower probability of stroke than those without acupuncture treatment during the follow-up period (p<0.0001).ConclusionPatients with TBI receiving acupuncture treatment show decreased risk of stroke compared with those without acupuncture treatment. However, this study was limited by lack of information regarding lifestyles, biochemical profiles, TBI severity, and acupuncture points used in treatments.

Highlights

Traumatic brain injury (TBI) is a common cause of disability and death in every age group and both sexes worldwide [1,2,3]
After propensity-score matching procedure (Table 1) there was no significant difference in age, sex, low income, area with traditional Chinese medicine (TCM) physician density, types of traumatic brain injury (TBI), mental disorders, hypertension, diabetes, ischemic heart disease, hyperlipidemia, migraine and epilepsy between TBI patients with and without acupuncture treatment
During the follow-up period (Table 2), TBI patients with acupuncture treatment (4.9 per 1000 person-years) had a lower incidence of new-onset stroke than those without acupuncture treatment (7.5 per 1000 person-years), with a hazard ratios (HRs) of 0.59 after adjustment for age, gender, low income, TCM physician density, type of TBI, diabetes mellitus, hypertension, hyperlipidemia, mental disorder, ischemic heart disease, migraine, epilepsy, anticoagulants, antiplatelet agents, and lipidlowering agents

Summary

Introduction

Traumatic brain injury (TBI) is a common cause of disability and death in every age group and both sexes worldwide [1,2,3]. Health problems after TBI include neurologic deficit, cognitive impairment, psychiatric illness, poor social functioning, and other significant adverse outcomes such as brain tumors and mortality [2,4,5,6,7]. This burden of disease calls for further investigation to prevent and treat complications after TBI [8]. Whether acupuncture can help to protect TBI patients from stroke has not previously been studied

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Conclusion