{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T06:59:03Z","timestamp":1781161143801,"version":"3.54.1"},"reference-count":66,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T00:00:00Z","timestamp":1753920000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T00:00:00Z","timestamp":1753920000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["PM&amp;amp;R"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Traumatic spinal cord injury (TSCI) and traumatic brain injury (TBI) remain health challenges with devastating biopsychological and socioeconomic consequences. The occurrence of dual diagnosis is a significant but poorly reported issue in U.S. emergency departments (EDs).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the trend, demographic, and socioeconomic aspects of dual diagnosis compared to isolated TSCI and TBI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Observational cross\u2010sectional study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Nationwide Emergency Departments Sample, 2006\u20132020.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>\n                      Data were extracted on number of ED visits nationwide by patients over 18 years of age with\n                      <jats:styled-content style=\"fixed-case\">TBI<\/jats:styled-content>\n                      ,\n                      <jats:styled-content style=\"fixed-case\">TSCI<\/jats:styled-content>\n                      , and dual diagnoses based on\n                      <jats:italic>International Classification of Diseases, Ninth Revision, Clinical Modification<\/jats:italic>\n                      and\n                      <jats:italic>Tenth Revision, Clinical Modification<\/jats:italic>\n                      codes. From 2006 to 2020, there were 23,826,719\n                      <jats:styled-content style=\"fixed-case\">TBI<\/jats:styled-content>\n                      and\n                      <jats:styled-content style=\"fixed-case\">TSCI<\/jats:styled-content>\n                      related visits to\n                      <jats:styled-content style=\"fixed-case\">EDs<\/jats:styled-content>\n                      nationwide. Of these, 68,578 were dual diagnoses (\n                      <jats:styled-content style=\"fixed-case\">TSCI<\/jats:styled-content>\n                      +\n                      <jats:styled-content style=\"fixed-case\">TBI<\/jats:styled-content>\n                      ), 23,579,060 were isolated\n                      <jats:styled-content style=\"fixed-case\">TBIs<\/jats:styled-content>\n                      , and 356,562 were isolated\n                      <jats:styled-content style=\"fixed-case\">TSCIs<\/jats:styled-content>\n                      .\n                    <\/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 Outcome Measures<\/jats:title>\n                    <jats:p>Trend analysis of dual diagnoses, TBI (mild, moderate, severe), and TSCI (cervical, thoracic, lumbar\/sacral\/cauda equina). Demographics including gender, age, income quartile, comorbidities, and hospital characteristics were compared between TSCI+TBI, TBI alone, and TSCI alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There was an increase of 201 dual diagnosis ED visits per year from 2012 onwards and an increase of 465 TSCI ED visits per year from 2017. However, TBIs declined from 2014 onwards, following the Centers for Disease Control and Prevention's reclassification of unspecified TBI. Patients with dual diagnosis had a median age of 50\u2009years and were predominantly male. Private insurance (TSCI+TBI: 39%; TBI: 32%; TSCI: 27%) was the most used by patients with dual diagnosis, although 29% (vs. TBI: 27%; TSCI: 32%) were in the lowest income quartiles. Most reported ED visits were in the southern United States, and most were at university hospitals. Importantly, patients treated at level 1 trauma hospitals were primarily dual diagnosis (48%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>TSCI alone and dual diagnosis visits are rising nationally in EDs; these patients have higher morbidity rates and may require more specialized care. These patients are among the most vulnerable socioeconomically. The increase in ED visits among these populations underscores the need for adequate and sufficient outpatient care to support their ongoing treatment and recovery.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pmrj.13440","type":"journal-article","created":{"date-parts":[[2025,7,31]],"date-time":"2025-07-31T11:16:34Z","timestamp":1753960594000},"page":"270-280","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Epidemiology of traumatic spinal cord injury and traumatic brain injury treated in emergency departments in the United States: 2006 to 2020"],"prefix":"10.1002","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1490-605X","authenticated-orcid":false,"given":"Axler Jean","family":"Paul","sequence":"first","affiliation":[{"name":"Kentucky Spinal Cord Injury Research Center (KSCIRC), University of Louisville  Louisville Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1051-6794","authenticated-orcid":false,"given":"Elsa","family":"Alvarez","sequence":"additional","affiliation":[{"name":"Kentucky Spinal Cord Injury Research Center (KSCIRC), University of Louisville  Louisville Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julian","family":"Marcet","sequence":"additional","affiliation":[{"name":"School of Medicine 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"}]},{"given":"Kelly","family":"Gartner","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery University of Louisville  Louisville Kentucky USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darryl","family":"Kaelin","sequence":"additional","affiliation":[{"name":"Division of Physical Medicine and Rehabilitation 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":"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"}]}],"member":"311","published-online":{"date-parts":[[2025,7,31]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.ss6609a1"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00415\u2010019\u201009541\u20104"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.12786\/bn.2021.14.e25"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1227\/neu.0000000000002479"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.neuchi.2020.02.002"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.4103\/jfmpc.jfmpc_1913_20"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/NRL.0000000000000532"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.5811\/westjem.2016.9.30574"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474\u20104422(18)30415\u20100"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2020.04.001"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474\u20104422(18)30444\u20107"},{"key":"e_1_2_11_13_1","volume-title":"Traumatic Spinal Cord Injury Facts and Figures at a Glance","author":"Center NSCIS","year":"2023"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2021.09.019"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1310\/sci2015\u2010313"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.2340\/16501977\u20101261"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2007.11.055"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.5555\/uri:pii:0003999388900147"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41393-022-00851-5"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1080\/10790268.2018.1465744"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmr.2014.04.005"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1080\/10790268.2021.1947680"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1159\/000524867"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1080\/10790268.2020.1851857"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clineuro.2014.05.013"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.3171\/spi.2006.5.3.210"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.3390\/jpm12071108"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen\u20102018\u2010023785"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.1177\/21925682211031190"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2013.3098"},{"issue":"6","key":"e_1_2_11_31_1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0252673","article-title":"Long\u2010term medical and productivity costs of severe trauma: results from a prospective cohort study","volume":"16","author":"Vlegel M","year":"2021","journal-title":"PLoS One"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1097\/htr.0000000000000153"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0010-9452(08)70924-9"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.3233\/NRE-2010-0557"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-199801000-00004"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlr.0000182534.19832.83"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.25653"},{"key":"e_1_2_11_38_1","doi-asserted-by":"publisher","DOI":"10.2147\/clep.S241610"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472\u20106963\u201010\u2010140"},{"key":"e_1_2_11_40_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurpub\/cku221"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2015.4126"},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474\u20104422(17)30371\u2010X"},{"key":"e_1_2_11_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2021.11.001"},{"key":"e_1_2_11_44_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.ss6609a1"},{"key":"e_1_2_11_45_1","doi-asserted-by":"publisher","DOI":"10.1227\/neu.0000000000002816"},{"key":"e_1_2_11_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.expneurol.2013.06.006"},{"key":"e_1_2_11_47_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2011-301875"},{"key":"e_1_2_11_48_1","doi-asserted-by":"publisher","DOI":"10.1212\/01.wnl.0000201276.28141.40"},{"key":"e_1_2_11_49_1","doi-asserted-by":"publisher","DOI":"10.1038\/sc.2011.178"},{"key":"e_1_2_11_50_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12963\u2010017\u20100150\u20104"},{"key":"e_1_2_11_51_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2013.22"},{"key":"e_1_2_11_52_1","unstructured":"The Traumatic Brain Injury Model Systems National Institute on Disability and Rehabilitation Research. Accessed June 04 2024 https:\/\/msktc.org\/sites\/default\/files\/lib\/docs\/TBI%20Model%20Systems_brochure_2010.pdf#:~:text=The%20following%20information%20is%20based%20on%20data%20from average%20age%20%3D%2039%3B%20male%20%2874%25%29%3B%20minority%20population"},{"key":"e_1_2_11_53_1","unstructured":"National Database: 2023 Profile of People within the Traumatic Brain Injury Model Systems.https:\/\/msktc.org\/sites\/default\/files\/TBIMS-NatDatabase-2023-508.pdf."},{"key":"e_1_2_11_54_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0003\u20109993(99)90263\u20100"},{"key":"e_1_2_11_55_1","doi-asserted-by":"publisher","DOI":"10.1080\/10790268.2006.11753886"},{"key":"e_1_2_11_56_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2012.01.022"},{"key":"e_1_2_11_57_1","unstructured":"KrausLL ColemanR HoutenvilleA.Disability Statistics Annual Report.2017https:\/\/files.eric.ed.gov\/fulltext\/ED583258.pdf"},{"key":"e_1_2_11_58_1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph20095643"},{"key":"e_1_2_11_59_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2022.942001"},{"key":"e_1_2_11_60_1","unstructured":"NicholsAJM LindnerS.Consequences of Long\u2010Term Unemployment.2013https:\/\/www.urban.org\/sites\/default\/files\/publication\/23921\/412887-Consequences-of-Long-Term-Unemployment.PDF"},{"key":"e_1_2_11_61_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMsa052049"},{"key":"e_1_2_11_62_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1995.03520290047028"},{"key":"e_1_2_11_63_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00068\u2010022\u201001885\u20103"},{"key":"e_1_2_11_64_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553\u20102712.2010.00918.x"},{"key":"e_1_2_11_65_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475\u20106773.14148"},{"key":"e_1_2_11_66_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2020.03.009"},{"key":"e_1_2_11_67_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pgph.0002230"}],"container-title":["PM&amp;R"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pmrj.13440","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/pmrj.13440","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pmrj.13440","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T06:31:26Z","timestamp":1781159486000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pmrj.13440"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,31]]},"references-count":66,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1002\/pmrj.13440"],"URL":"https:\/\/doi.org\/10.1002\/pmrj.13440","archive":["Portico"],"relation":{},"ISSN":["1934-1482","1934-1563"],"issn-type":[{"value":"1934-1482","type":"print"},{"value":"1934-1563","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,31]]},"assertion":[{"value":"2024-07-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-05-02","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-31","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}