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Citation
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Dismuke-Greer C, Hirsch S, Carlson K, Pogoda T, Nakase-Richardson R, Bhatnagar S, Eapen B, Troyanskaya M, Miles S, Nolen T, Walker WC. Arch. Phys. Med. Rehabil. 2020; ePub(ePub): ePub. |
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Abstract
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OBJECTIVE: To compare Veterans Administration (VA) diagnoses, health services utilization and costs by mild traumatic brain injury (mTBI) group (Blast-Related (BR) mTBI vs. non-Blast-Related (NBR) mTBI vs. no mTBI) among Operation Enduring Freedom(OEF)/Operation Iraqi Freedom (OIF)/Operation New Dawn (OND) veterans in the Chronic Effects of Neurotrauma Consortium (CENC) multicenter observational study.
DESIGN: Prospective Cohort Study.
SETTING: 4 VA Medical Centers (VAMCs).
PARTICIPANTS: OEF/OIF/OND veterans who utilized VAMCs services between 2002-2017.
INTERVENTIONS: Not applicable. Lifetime mTBI history was assessed via semi-structured interviews.
MAIN OUTCOME MEASURES: VA diagnoses, health services utilization and costs.
RESULTS: Relative to NBR mTBI and no mTBI, veterans with BR mTBI were more likely to be male, have greater combat, controlled and uncontrolled detonations exposures (median BR=15.0 vs NBR=3.0 vs no mTBI=3.0). They also had higher prevalence of headache, posttraumatic stress disorder (PTSD) and anxiety diagnoses. Veterans with BR had the highest site adjusted mean annual VHA utilization (26.31 visits; 95% CI 26.01:26.61), relative to NBR (20.43 visits; 95% CI 20.15:20.71), and no mTBI (16.62 visits; 95% CI 16.21:17.04), and highest site adjusted mean annual VHA outpatient costs ($6,480; 95% CI $5,842:$7,187), relative to NBR ($4,901; 95% CI $4,392:$5,468), and no mTBI ($4,069; 95% CI $3,404:$4,864).
CONCLUSIONS: Veterans with BR mTBI had higher exposure to combat and detonation. BR was associated with greater prevalence of select diagnoses, and higher health services utilization and costs, relative to NBR and no mTBI. The role of health care needs from mTBI polytrauma, other deployment-related exposures, and VHA access warrants future research.
Language: en |