Outcomes comparative analysis of concurrent traumatic brain injury and traumatic spinal cord injury versus isolated traumatic brain injury and isolated traumatic spinal cord injury

BACKGROUND: Concomitant traumatic brain injury (TBI) and traumatic spinal cord injury (TSCI) have been understudied despite their occurrence in approximately 40%-60% of TSCI cases and approximately 4%-13% of TBI cases. OBJECTIVE: To compare outcomes between concurrent TBI and TSCI (TBI + TSCI) to isolated TBI and TSCI. DESIGN: Observational longitudinal study. SETTING: Merative MarketScan Research Database (2000-2022). PARTICIPANTS: Data for individuals 18 years or older who were hospitalized for TBI or TSCI were extracted and separated into three groups: 200,018 TBI; 17,045 TSCI; and 5486 TBI + TSCI. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Demographics, comorbidities, index hospitalization length of stay, index payments, index complications, discharge disposition, 12-month rehabilitation use, 12-month complications, health care use (emergency department visits, outpatient services, hospitalizations, medications), 12-month post-discharge payments, and total payments. RESULTS: Patients with TBI + TSCI were overall younger than those with isolated TBI or TSCI. Patients with TBI + TSCI had more commercial insurance coverage but less Medicare and Medicaid coverage compared to those with isolated injuries. Individuals with TBI + TSCI had the greatest index payments and were the least likely to be discharged home. At 12 months post-discharge, 73% of individuals with concurrent injuries had at least one complication, higher than the complication rates of isolated TBI or TSCI. However, the TBI + TSCI group had lower prescription medication refills than the groups with isolated injuries. Individuals with TBI + TSCI used fewer rehabilitation services and had lower 12-month post-discharge payments than those with isolated TSCI but used more rehabilitation services and had higher payments than those with isolated TBI. Total payments were greatest in TBI + TSCI cases. CONCLUSION: Overall, patients with co-occurring TBI + TSCI had higher complication rates and payments compared to TBI alone and TSCI alone. Gaining deeper insights into the complexities, health care requirements, and economic impact of concurrent TBI + TSCI can facilitate the development of tailored and effective treatment management strategies.