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Stroke subtype linked to 1-year readmission and dementia risk in Scottish cohortWhich stroke type leads to higher death or readmission risks in Scotland?

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Key Takeaway
Consider that lobar ICH and cortical ischemic stroke show distinct outcome risks in this observational Scottish cohort.

This was a matched cohort study using healthcare data from Scotland between 2010 and 2018. The population included 785,331 people with a head scan, with 64,219 having clinical stroke phenotypes. Subtypes analyzed were deep ischemic stroke (12,616 people), cortical ischemic stroke (14,103 people), deep ICH (1,814 people), and lobar ICH (1,456 people). The comparator was age- and sex-matched controls who never had a stroke.

The primary exposure was stroke subtype, and the primary outcome was risk of death and other outcomes after stroke. For 1-year hospital readmission, lobar ICH had a higher absolute rate than deep ICH: 4.9% vs 3.4% (95%CI 3.9% - 6.1% vs 2.6% - 4.3%).

Beyond 6 months, the risk of dementia was higher for lobar ICH versus controls (aHR 3.5, 95%CI 2.3-5.3). Within 6 months of cortical ischemic stroke, the risk of myocardial infarction was higher versus other stroke subtypes (aHR 4.6, 95%CI 3.4-6.3).

Safety and tolerability data were not reported. A key limitation is that healthcare systems data studies do not include subtyping information, which was addressed via natural language processing (NLP).

The practice relevance is that NLP of free-text reports linked to coded data successfully subtyped stroke at scale, enabling large-scale audit and epidemiology of people with stroke. These observational associations do not imply causation.

Imagine having a stroke and wondering what your future holds. A new study looked at nearly 800,000 people in Scotland who had head scans between 2010 and 2018. Researchers used computer tools to sort out exactly what kind of stroke each person had, comparing them to similar people who never had a stroke. They wanted to know if the specific type of stroke changed the risk of dying or needing the hospital again within a year.

The findings were clear for some groups. People with lobar intracerebral hemorrhage, a type of bleeding stroke, had a higher rate of being readmitted to the hospital compared to those with deep bleeding strokes. Additionally, those who had cortical ischemic strokes faced a much higher risk of having a heart attack within six months. The study also found that lobar bleeding was strongly linked to a higher risk of developing dementia later on.

This research matters because it helps doctors understand which stroke types are most dangerous. By using computer analysis on medical notes, the team could look at huge numbers of patients to spot these patterns. However, the study has limits. Because it used existing health records, it could not prove that the stroke type directly caused the heart attacks or dementia, only that they happened together. Still, knowing these risks helps patients and families prepare for what might come next.

What this means for you:
Specific stroke types in Scotland are linked to higher risks of death, readmission, heart attacks, and dementia.

Study Details

Study typeCohort
EvidenceLevel 3
PublishedApr 2026
View Original Abstract ↓
Background Outcome after stroke varies according to stroke subtype by location, but healthcare systems data studies do not include subtyping information. We linked natural language processing (NLP) of brain imaging reports to routinely collected data to estimate risk of death and other outcomes after stroke subtypes in a nationwide dataset. Methods We applied a previously validated NLP algorithm to all CT and MRI head scan reports in Scotland between 2010 and 2018. We linked the reports to hospital readmissions, prescriptions and death data to identify and characterize people with stroke, and to categorize into deep and cortical ischemic stroke, deep and lobar intracerebral hemorrhage (ICH), subarachnoid hemorrhage, and subdural hemorrhage. We used a matched cohort design, and age- and sex-matched four controls per case who never had a stroke. By subtype, we estimated rehospitalization with stroke, myocardial infarction (MI), cancer, dementia, epilepsy and death, accounting for confounders and competing risk of death. Results From 785,331 people with a head scan, we identified 64,219 with clinical stroke phenotypes (mean age 73.4yrs, 49.5% male), and subtyped 12,616 with deep ischaemic stroke; 14,103 with cortical ischaemic stroke; 1,814 with deep ICH; and 1,456 with lobar ICH. There was higher absolute rate of 1-year hospital readmission for lobar compared with deep ICH (4.9% [95%CI 3.9% - 6.1%] vs 3.4% [2.6% - 4.3%]), higher risk of dementia beyond 6 months after lobar ICH compared to controls than for other stroke subtypes (aHR 3.5 [2.3-5.3]); and higher risk of MI within 6 months of cortical ischemic stroke than for other stroke subtypes (aHR 4.6 [3.4-6.3]). Conclusions NLP of free-text reports linked to coded data successfully subtyped stroke at scale, and we estimated risk of clinically relevant outcomes. Future work should use free text to enable large-scale audit and epidemiology of people with stroke.
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