{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T00:27:16Z","timestamp":1783384036054,"version":"3.54.6"},"reference-count":54,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,6,28]],"date-time":"2025-06-28T00:00:00Z","timestamp":1751068800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["PM&amp;R"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Independently, traumatic brain injuries (TBI) and traumatic spinal cord injuries (TSCI) can be catastrophic for patients and their caregivers. However, the potential additive effect in the dual diagnosis (DD) of these injuries remains poorly understood.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To elucidate the health care utilization and costs associated with DD compared to isolated mild, moderate, or severe TBI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Retrospective observational longitudinal study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Merative MarketScan Research Database (2000\u20132022).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Individuals 18\u2009years or older who were hospitalized for TBI (205,504 total) were separated into study groups: (1) 105,324 mild TBI; (2) 93,499 moderate TBI; (3) 1195 severe TBI; and (4) 5486 DD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Not applicable.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcomes<\/jats:title>\n                    <jats:p>Demographics, comorbidities, complications, and health care utilization (index hospitalization length of stay, rehabilitation services, emergency room visits, outpatient services, payments).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The median age for patients with DD was 51 years, significantly higher than that for patients with mild and moderate TBI. Patients with DD had the highest proportion of individuals with no comorbidities at the time of injury. During index hospitalization, patients with DD had higher complication rates, length of stay, and payments than patients with mild and moderate TBI. At 12\u2009months post\u2010discharge, patients with DD had higher rates of renal\u2010genital\u2010urinary, neuromusculoskeletal, and gastrointestinal complications compared to all isolated TBI groups. Additionally, patients with DD were more likely to utilize at least one rehabilitation service. Patients with DD had 5% higher rate of hospitalizations compared to patients with\u00a0moderate TBI and greater utilization of outpatient services compared to those with mild and moderate TBI. Patients with DD had significantly higher total payments at 12\u2009months than those with mild and moderate TBI but lower payments than those with severe TBI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our findings show worse outcomes and higher health care utilization for individuals with DD compared to those with mild and moderate TBI and similar or slightly better outcomes and utilization compared to those with severe TBI. This study highlights the challenges of DD and provides data to support specialized resource allocation for patients with DD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pmrj.13404","type":"journal-article","created":{"date-parts":[[2025,6,28]],"date-time":"2025-06-28T04:04:23Z","timestamp":1751083463000},"page":"1321-1333","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Health care utilization and cost in the dual diagnosis of combined traumatic spinal cord injury and traumatic brain injury compared to traumatic brain injury alone: An analysis using\n                    <scp>MarketScan<\/scp>"],"prefix":"10.1002","volume":"17","author":[{"given":"Julian","family":"Marcet","sequence":"first","affiliation":[{"name":"School of Medicine, University of Louisville  Louisville Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1051-6794","authenticated-orcid":false,"given":"Elsa","family":"Alvarez\u2010Madrid","sequence":"additional","affiliation":[{"name":"Kentucky Spinal Cord Injury Research Center (KSCIRC), University of Louisville  Louisville Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zakari","family":"Dymock","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery University of Louisville  Louisville Kentucky USA"},{"name":"Division of Physical Medicine and Rehabilitation University of Louisville  Louisville Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"McKenna","family":"Hamm","sequence":"additional","affiliation":[{"name":"Kentucky Spinal Cord Injury Research Center (KSCIRC), University of Louisville  Louisville Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1490-605X","authenticated-orcid":false,"given":"Axler Jean","family":"Paul","sequence":"additional","affiliation":[{"name":"Kentucky Spinal Cord Injury Research Center (KSCIRC), University of Louisville  Louisville Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelly E.","family":"Gartner","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery University of Louisville  Louisville Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4118-4638","authenticated-orcid":false,"given":"Camilo","family":"Castillo","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery University of Louisville  Louisville Kentucky USA"},{"name":"Division of Physical Medicine and Rehabilitation University of Louisville  Louisville Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatrice","family":"Ugiliweneza","sequence":"additional","affiliation":[{"name":"Kentucky Spinal Cord Injury Research Center (KSCIRC), University of Louisville  Louisville Kentucky USA"},{"name":"Department of Anatomical Sciences and Neurobiology (ASNB) University of Louisville  Louisville Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darryl","family":"Kaelin","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery University of Louisville  Louisville Kentucky USA"},{"name":"Division of Physical Medicine and Rehabilitation University of Louisville  Louisville Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,6,28]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.suc.2017.06.003"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.2174\/1570159X15666170613083606"},{"issue":"4","key":"e_1_2_11_4_1","first-page":"237","article-title":"Update on traumatic acute spinal cord injury. 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