Outcomes comparative analysis of concurrent traumatic brain injury and traumatic spinal cord injury versus isolated traumatic brain injury and isolated traumatic spinal cord injury.

BACKGROUND

Concomitant traumatic brain injury (TBI) and traumatic spinal cord injury (TSCI) have been understudied despite their occurrence in approximately 40%-60% of TSCI cases and approximately 4%-13% of TBI cases.

OBJECTIVE

To compare outcomes between concurrent TBI and TSCI (TBI + TSCI) to isolated TBI and TSCI.

DESIGN

Observational longitudinal study.

SETTING

Merative MarketScan Research Database (2000-2022).

PARTICIPANTS

Data for individuals 18 years or older who were hospitalized for TBI or TSCI were extracted and separated into three groups: 200,018 TBI; 17,045 TSCI; and 5486 TBI + TSCI.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Demographics, comorbidities, index hospitalization length of stay, index payments, index complications, discharge disposition, 12-month rehabilitation use, 12-month complications, health care use (emergency department visits, outpatient services, hospitalizations, medications), 12-month post-discharge payments, and total payments.

RESULTS

Patients with TBI + TSCI were overall younger than those with isolated TBI or TSCI. Patients with TBI + TSCI had more commercial insurance coverage but less Medicare and Medicaid coverage compared to those with isolated injuries. Individuals with TBI + TSCI had the greatest index payments and were the least likely to be discharged home. At 12 months post-discharge, 73% of individuals with concurrent injuries had at least one complication, higher than the complication rates of isolated TBI or TSCI. However, the TBI + TSCI group had lower prescription medication refills than the groups with isolated injuries. Individuals with TBI + TSCI used fewer rehabilitation services and had lower 12-month post-discharge payments than those with isolated TSCI but used more rehabilitation services and had higher payments than those with isolated TBI. Total payments were greatest in TBI + TSCI cases.

CONCLUSION

Overall, patients with co-occurring TBI + TSCI had higher complication rates and payments compared to TBI alone and TSCI alone. Gaining deeper insights into the complexities, health care requirements, and economic impact of concurrent TBI + TSCI can facilitate the development of tailored and effective treatment management strategies.