Health care utilization and cost in the dual diagnosis of combined traumatic spinal cord injury and traumatic brain injury compared to traumatic brain injury alone: An analysis using MarketScan.

BACKGROUND

Independently, traumatic brain injuries (TBI) and traumatic spinal cord injuries (TSCI) can be catastrophic for patients and their caregivers. However, the potential additive effect in the dual diagnosis (DD) of these injuries remains poorly understood.

OBJECTIVE

To elucidate the health care utilization and costs associated with DD compared to isolated mild, moderate, or severe TBI.

DESIGN

Retrospective observational longitudinal study.

SETTING

Merative MarketScan Research Database (2000-2022).

PARTICIPANTS

Individuals 18 years or older who were hospitalized for TBI (205,504 total) were separated into study groups: (1) 105,324 mild TBI; (2) 93,499 moderate TBI; (3) 1195 severe TBI; and (4) 5486 DD.

INTERVENTIONS: Not applicable.

MAIN OUTCOMES: Demographics, comorbidities, complications, and health care utilization (index hospitalization length of stay, rehabilitation services, emergency room visits, outpatient services, payments).

RESULTS

The median age for patients with DD was 51 years, significantly higher than that for patients with mild and moderate TBI. Patients with DD had the highest proportion of individuals with no comorbidities at the time of injury. During index hospitalization, patients with DD had higher complication rates, length of stay, and payments than patients with mild and moderate TBI. At 12 months post-discharge, patients with DD had higher rates of renal-genital-urinary, neuromusculoskeletal, and gastrointestinal complications compared to all isolated TBI groups. Additionally, patients with DD were more likely to utilize at least one rehabilitation service. Patients with DD had 5% higher rate of hospitalizations compared to patients with moderate TBI and greater utilization of outpatient services compared to those with mild and moderate TBI. Patients with DD had significantly higher total payments at 12 months than those with mild and moderate TBI but lower payments than those with severe TBI.

CONCLUSION

Our findings show worse outcomes and higher health care utilization for individuals with DD compared to those with mild and moderate TBI and similar or slightly better outcomes and utilization compared to those with severe TBI. This study highlights the challenges of DD and provides data to support specialized resource allocation for patients with DD.