Original research| Volume 101, ISSUE 10, P1720-1730, October 2020

Health Services Utilization, Health Care Costs, and Diagnoses by Mild Traumatic Brain Injury Exposure: A Chronic Effects of Neurotrauma Consortium Study



      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.


      Prospective cohort study.


      Four Veterans Affairs Medical Centers.


      OEF/OIF/OND veterans (N=472) who used Veterans Affairs Medical Centers services between 2002-2017.


      Not applicable. Lifetime mTBI history was assessed via semistructured interviews.

      Main Outcome Measures

      VHA diagnoses, health services utilization, and costs.


      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).


      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.


      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)
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