Donald McGeary, Alicia A Swan, Eamonn Kennedy, Clara E Dismuke-Greer, Cindy McGeary, Jason J Sico, Megan E Amuan, Ajay Manhapra, Erin D Bouldin, Paul Watson, Kimbra Kenney, Maddy Myers, J Kent Werner, James L Mitchell, Kathleen Carlson, Roxana Delgado, Aryan Esmaeili, Mary Jo Pugh
{"title":"脑外伤后的慢性头痛:诊断复杂性与成本增加相关。","authors":"Donald McGeary, Alicia A Swan, Eamonn Kennedy, Clara E Dismuke-Greer, Cindy McGeary, Jason J Sico, Megan E Amuan, Ajay Manhapra, Erin D Bouldin, Paul Watson, Kimbra Kenney, Maddy Myers, J Kent Werner, James L Mitchell, Kathleen Carlson, Roxana Delgado, Aryan Esmaeili, Mary Jo Pugh","doi":"10.3233/NRE-230277","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Chronic headache after traumatic brain injury (TBI) is a common, yet disabling, disorder whose diverse clinical characteristics and treatment needs remain poorly defined.</p><p><strong>Objective: </strong>To examine diagnostic coding patterns and cost among military Veterans with comorbid chronic headache and TBI.</p><p><strong>Methods: </strong>We identified 141,125 post-9/11 era Veterans who served between 2001 and 2019 with a headache disorder diagnosed after TBI. We first identified patterns of Complex Headache Combinations (CHC) and then compared the patterns of healthcare costs in 2022-dollar values in the three years following the TBI diagnosis.</p><p><strong>Results: </strong>Veterans had diverse individual headache and CHC diagnoses with uniformly high cost of care. Post-whiplash and post-TBI CHCs were common and consistently associated with higher costs after TBI than those with other types of headache and CHCs. Post-TBI migraine had the highest unadjusted mean inpatient ($27,698), outpatient ($61,417), and pharmacy ($4,231) costs, which persisted even after adjustment for confounders including demographic, military, and clinical characteristics.</p><p><strong>Conclusion: </strong>Headache diagnoses after TBI, particularly those diagnosed with post-traumatic headache, are complex, and associated with dual high cost and care burdens. More research is needed to examine whether this higher expenditure reflects more intensive treatment and better outcomes or refractory headache with worse outcomes.</p>","PeriodicalId":19717,"journal":{"name":"NeuroRehabilitation","volume":" ","pages":"303-317"},"PeriodicalIF":1.7000,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11613006/pdf/","citationCount":"0","resultStr":"{\"title\":\"Chronic headaches after traumatic brain injury: Diagnostic complexity associated with increased cost.\",\"authors\":\"Donald McGeary, Alicia A Swan, Eamonn Kennedy, Clara E Dismuke-Greer, Cindy McGeary, Jason J Sico, Megan E Amuan, Ajay Manhapra, Erin D Bouldin, Paul Watson, Kimbra Kenney, Maddy Myers, J Kent Werner, James L Mitchell, Kathleen Carlson, Roxana Delgado, Aryan Esmaeili, Mary Jo Pugh\",\"doi\":\"10.3233/NRE-230277\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Chronic headache after traumatic brain injury (TBI) is a common, yet disabling, disorder whose diverse clinical characteristics and treatment needs remain poorly defined.</p><p><strong>Objective: </strong>To examine diagnostic coding patterns and cost among military Veterans with comorbid chronic headache and TBI.</p><p><strong>Methods: </strong>We identified 141,125 post-9/11 era Veterans who served between 2001 and 2019 with a headache disorder diagnosed after TBI. We first identified patterns of Complex Headache Combinations (CHC) and then compared the patterns of healthcare costs in 2022-dollar values in the three years following the TBI diagnosis.</p><p><strong>Results: </strong>Veterans had diverse individual headache and CHC diagnoses with uniformly high cost of care. Post-whiplash and post-TBI CHCs were common and consistently associated with higher costs after TBI than those with other types of headache and CHCs. Post-TBI migraine had the highest unadjusted mean inpatient ($27,698), outpatient ($61,417), and pharmacy ($4,231) costs, which persisted even after adjustment for confounders including demographic, military, and clinical characteristics.</p><p><strong>Conclusion: </strong>Headache diagnoses after TBI, particularly those diagnosed with post-traumatic headache, are complex, and associated with dual high cost and care burdens. More research is needed to examine whether this higher expenditure reflects more intensive treatment and better outcomes or refractory headache with worse outcomes.</p>\",\"PeriodicalId\":19717,\"journal\":{\"name\":\"NeuroRehabilitation\",\"volume\":\" \",\"pages\":\"303-317\"},\"PeriodicalIF\":1.7000,\"publicationDate\":\"2024-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11613006/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"NeuroRehabilitation\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.3233/NRE-230277\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CLINICAL NEUROLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"NeuroRehabilitation","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.3233/NRE-230277","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}
Chronic headaches after traumatic brain injury: Diagnostic complexity associated with increased cost.
Background: Chronic headache after traumatic brain injury (TBI) is a common, yet disabling, disorder whose diverse clinical characteristics and treatment needs remain poorly defined.
Objective: To examine diagnostic coding patterns and cost among military Veterans with comorbid chronic headache and TBI.
Methods: We identified 141,125 post-9/11 era Veterans who served between 2001 and 2019 with a headache disorder diagnosed after TBI. We first identified patterns of Complex Headache Combinations (CHC) and then compared the patterns of healthcare costs in 2022-dollar values in the three years following the TBI diagnosis.
Results: Veterans had diverse individual headache and CHC diagnoses with uniformly high cost of care. Post-whiplash and post-TBI CHCs were common and consistently associated with higher costs after TBI than those with other types of headache and CHCs. Post-TBI migraine had the highest unadjusted mean inpatient ($27,698), outpatient ($61,417), and pharmacy ($4,231) costs, which persisted even after adjustment for confounders including demographic, military, and clinical characteristics.
Conclusion: Headache diagnoses after TBI, particularly those diagnosed with post-traumatic headache, are complex, and associated with dual high cost and care burdens. More research is needed to examine whether this higher expenditure reflects more intensive treatment and better outcomes or refractory headache with worse outcomes.
期刊介绍:
NeuroRehabilitation, an international, interdisciplinary, peer-reviewed journal, publishes manuscripts focused on scientifically based, practical information relevant to all aspects of neurologic rehabilitation. We publish unsolicited papers detailing original work/research that covers the full life span and range of neurological disabilities including stroke, spinal cord injury, traumatic brain injury, neuromuscular disease and other neurological disorders.
We also publish thematically organized issues that focus on specific clinical disorders, types of therapy and age groups. Proposals for thematic issues and suggestions for issue editors are welcomed.