Coexistence of Acute Ischemic Stroke and Acute Bone Fracture during Hospitalization

Background: Stroke and bone fracture may manifest as risk factors and complications for each other. Stroke and bone fracture may occur concurrently in patients presented to the emergency department. Methods: Between January 2007 and December 2018, we retrospectively found 30 patients with coexistent acute ischemic stroke and bone fracture during hospitalization. Results: Concurrent stroke and fracture (initial stroke), stroke followed by fracture (initial stroke), and fracture followed by stroke (initial fracture) occurred in 17, 4, and 9 patients, respectively. Femur was the most common fracture location. Stroke or fracture was initially overlooked in 4 of 17 patients (24%) with concurrent stroke and bone fracture. Both age and the admission National Institutes of Health Stroke Scale (NIHSS) score exhibited a positive linear correlation with the discharge modified Rankin Scale (mRS). Univariate logistic regressions found that significant factors influencing unfavorable outcome (mRS > 3) were an admission NIHSS score > 5, age > 70 years, urinary catheterization, nasogastric insertion, anterior circulation, and initial fracture. Stepwise regression analyses showed that an admission NIHSS score > 5 (odds ratio [OR]: 48.36, 95% confidence interval [CI]: 1.19-1963.26, p = 0.040), age > 70 years (OR: 30.03, 95% CI: 1.57-574.48; p = 0.024), and anterior circulation (OR: 27.41, 95% CI: 1.31-572.65; p = 0.033) were significant predictors of unfavorable outcomes with a prediction value of up to 0.938. Conclusion: Coexistence of acute stroke and bone fracture is an uncommon but serious condition. Neurologists, orthopedics and emergency physicians need to be more vigilant toward this concomitance with careful clinical evaluation. Copyright (C) 2021, Taiwan Society of Geriatric Emergency & Critical Care Medicine.