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.

IF 2.8 4区 医学 Q1 REHABILITATION
PM&R Pub Date : 2025-06-28 DOI:10.1002/pmrj.13404
Julian Marcet, Elsa Alvarez-Madrid, Zakari Dymock, McKenna Hamm, Axler Jean Paul, Kelly E Gartner, Camilo Castillo, Beatrice Ugiliweneza, Darryl Kaelin
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引用次数: 0

Abstract

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.

与单纯颅脑损伤相比,创伤性脊髓损伤合并颅脑损伤双重诊断的医疗保健利用和成本:一项使用MarketScan的分析
背景:创伤性脑损伤(TBI)和创伤性脊髓损伤(TSCI)对患者及其护理人员来说可能是灾难性的。然而,这些损伤的双重诊断(DD)的潜在叠加效应仍然知之甚少。目的:阐明与孤立的轻度、中度或重度脑外伤相比,DD的医疗保健利用和费用。设计:回顾性观察性纵向研究。环境:Merative MarketScan研究数据库(2000-2022)。参与者:18岁及以上因TBI住院的个体(共205,504人)被分为研究组:(1)105,324轻度TBI;(2)中度脑损伤93499例;(3)重度颅脑损伤1195例;(4) 5486 dd .干预措施:不适用。主要结局:人口统计学、合并症、并发症和医疗保健利用(指数住院时间、康复服务、急诊室就诊、门诊服务、支付)。结果:DD患者的中位年龄为51岁,明显高于轻中度TBI患者。DD患者在损伤时无合并症的个体比例最高。在指数住院期间,DD患者的并发症发生率、住院时间和费用均高于轻度和中度TBI患者。出院后12个月,与所有孤立的TBI组相比,DD患者的肾脏-生殖器-泌尿、神经肌肉骨骼和胃肠道并发症发生率更高。此外,DD患者更有可能使用至少一种康复服务。与中度TBI患者相比,DD患者的住院率高出5%,与轻度和中度TBI患者相比,门诊服务的利用率更高。DD患者在12个月时的总支付额明显高于轻度和中度TBI患者,但低于重度TBI患者。结论:我们的研究结果表明,与轻度和中度TBI患者相比,DD患者的预后更差,医疗保健利用率更高,而与重度TBI患者相比,DD患者的预后和医疗保健利用率相似或略好。本研究强调了DD的挑战,并提供了支持DD患者的专门资源分配的数据。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
PM&R
PM&R REHABILITATION-SPORT SCIENCES
CiteScore
4.30
自引率
4.80%
发文量
187
审稿时长
4-8 weeks
期刊介绍: Topics covered include acute and chronic musculoskeletal disorders and pain, neurologic conditions involving the central and peripheral nervous systems, rehabilitation of impairments associated with disabilities in adults and children, and neurophysiology and electrodiagnosis. PM&R emphasizes principles of injury, function, and rehabilitation, and is designed to be relevant to practitioners and researchers in a variety of medical and surgical specialties and rehabilitation disciplines including allied health.
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