Abstract
Objective
To compare Veterans Health Administration (VHA) 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 multicenter observational study.
Design
Prospective cohort study.
Setting
Four Veterans Affairs Medical Centers.
Participants
OEF/OIF/OND veterans (N=472) who used Veterans Affairs Medical Centers services between
2002-2017.
Interventions
Not applicable. Lifetime mTBI history was assessed via semistructured interviews.
Main Outcome Measures
VHA 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, and have 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, and anxiety diagnoses. Veterans with BR had the highest
site-adjusted mean annual VHA utilization (26.31 visits; 95% confidence interval [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 ($6480; 95% CI, $5842-$7187) relative to NBR ($4901; 95% CI, $4392-$5468) and
no mTBI ($4069; 95% CI, $3404-$4864).
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.
Keywords
List of abbreviations:
BR (blast-related), CENC (Chronic Effects of Neurotrauma Consortium), CI (confidence interval), DoD (Department of Defense), ICD (International Classification of Diseases), mTBI (mild traumatic brain injury), NBR (non–blast-related), OEF (Operation Enduring Freedom), OIF (Operation Iraqi Freedom), OND (Operation New Dawn), PCE (potential concussive event), PTSD (posttraumatic stress disorder), TBI (traumatic brain injury), VA (Veterans Administration), VCU rCDI (Virginia Commonwealth University Retrospective Concussion Diagnostic Interview), VHA (Veterans Health Administration), VINCI (Veterans Affairs Informatics and Computing Infrastructure)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: July 09, 2020
Footnotes
Supported by the U.S. Army Medical Research and Materiel Command and from the U.S. Department of Veterans Affairs Chronic Effects of Neurotrauma Consortium (award no. W81XWH-13-2-0095). The U.S. Army Medical Research Acquisition Activity, 820 Chandler St, Fort Detrick, MD 21702-5014, is the awarding and administering acquisition office. Any opinions, findings, conclusions or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the U.S. Government, or the U.S. Department of Veterans Affairs, and no official endorsement should be inferred.
Disclosures: none.
Identification
Copyright
Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine
