{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T13:27:25Z","timestamp":1770989245945,"version":"3.50.1"},"reference-count":91,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2025,8,24]],"date-time":"2025-08-24T00:00:00Z","timestamp":1755993600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2025,8,24]],"date-time":"2025-08-24T00:00:00Z","timestamp":1755993600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100007924","name":"University of Louisville","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007924","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["PM&amp;R"],"published-print":{"date-parts":[[2026,2]]},"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) present their own health challenges and socioeconomic impact. Individuals with dual diagnosis (DD) of the two traumas may have different impacts on outcomes, health care utilization, and costs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the outcomes of DD compared to isolated TSCI at initial acute hospital stay and 12\u2009months after discharge across TSCI level and completeness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>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>Data were extracted for individuals with TSCI alone and DD who were over 18\u2009years of age. The study cohort was composed of 20,212 individuals with either TSCI alone or DD (TSCI+TBI). Injury level groups consisted of cervical incomplete TSCI (CI: 6310 alone, 3962 with TBI); cervical complete TSCI (CC: 393 alone, 269 with TBI); thoracic incomplete TSCI (TI: 3542 alone, 1014 with TBI); thoracic complete TSCI (TC: 508 alone, 210 with TBI); and lumber\/sacral\/cauda equina TSCI (LSCE: 3227 alone, 777 with TBI).<\/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>Demographics, initial acute hospital outcomes (length of stay, index payments, complications, discharge disposition), and 12\u2010month postdischarge outcomes (rehabilitation services, complications, overall health care utilization, and 12\u2010month payments).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Individuals with DD were predominantly younger, male, and commercially insured. During acute hospitalization, outcomes were worse for cervical and thoracic incomplete injuries and LSCE with DD compared to TSCI alone; CI\u2010DD had 9% higher rates of overall complications, and LSCE\u2010DD had 2\u2010day longer hospital stay. Median hospital payments were 1.5\u2010 to 2.7\u2010fold higher across most groups with DD, except for CC. One year after injury, overall complications were 5%\u201315% higher across all DD groups, with most differences in respiratory, cardiovascular, metabolic, and psychiatric complications. Health care utilization of rehabilitation services, emergency room visits, and 12\u2010month payments were similar or worse in DD groups compared to TSCI alone.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Individuals with DD had worse outcomes and higher health care utilization compared to those with isolated TSCI, including increased hospital payments, rehabilitation use, and overall complications in the first year after injury. Our findings highlight the increased burden of DD and contribute knowledge for future treatment decision\u2010making, resource allocation, and research initiatives.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pmrj.13447","type":"journal-article","created":{"date-parts":[[2025,8,25]],"date-time":"2025-08-25T06:55:23Z","timestamp":1756104923000},"page":"128-139","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Complications, health care utilization, and costs in dual diagnosis of traumatic spinal cord injury and traumatic brain injury compared to traumatic spinal cord injury alone"],"prefix":"10.1002","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1051-6794","authenticated-orcid":false,"given":"Elsa","family":"Alvarez\u2010Madrid","sequence":"first","affiliation":[{"name":"Kentucky Spinal Cord Injury Research Center (KSCIRC) University of Louisville  Louisville Kentucky USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Julian","family":"Marcet","sequence":"additional","affiliation":[{"name":"School of Medicine University of Louisville  Louisville Kentucky USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"McKenna","family":"Hamm","sequence":"additional","affiliation":[{"name":"Kentucky Spinal Cord Injury Research Center (KSCIRC) University of Louisville  Louisville Kentucky USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1490-605X","authenticated-orcid":false,"given":"Axler","family":"Jean Paul","sequence":"additional","affiliation":[{"name":"Kentucky Spinal Cord Injury Research Center (KSCIRC) University of Louisville  Louisville Kentucky USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kelly E.","family":"Gartner","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery University of Louisville  Louisville Kentucky USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"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":[{"role":"author","vocabulary":"crossref"}]},{"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":[{"role":"author","vocabulary":"crossref"}]},{"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":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,8,24]]},"reference":[{"key":"e_1_2_14_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pmr.2014.04.005"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2007.11.055"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1474\u20104422(18)30415\u20100"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2023-075049"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(20)32340-0"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.1310\/sci1604-1"},{"issue":"5","key":"e_1_2_14_8_1","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0216743","article-title":"In\u2010hospital costs after severe traumatic brain injury: a systematic review and quality assessment","volume":"14","author":"Dijck JT","year":"2019","journal-title":"PLoS One"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.ta.0000174732.90517.df"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.sc.3100501"},{"key":"e_1_2_14_11_1","unstructured":"Center NSCIS.Traumatic spinal cord injury facts and figures at a glance. Model Systems Knowledge Translation Center2024."},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.4103\/1673-5374.158329"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.1179\/2042618613Y.0000000053"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.46292\/sci2702-225"},{"key":"e_1_2_14_15_1","doi-asserted-by":"publisher","DOI":"10.1177\/2045125317753340"},{"key":"e_1_2_14_16_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199008233230801"},{"key":"e_1_2_14_17_1","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2013.3301"},{"key":"e_1_2_14_18_1","doi-asserted-by":"publisher","DOI":"10.4103\/1673-5374.290883"},{"key":"e_1_2_14_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ucl.2010.06.005"},{"key":"e_1_2_14_20_1","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2010.00149"},{"key":"e_1_2_14_21_1","first-page":"369","article-title":"The pathogenesis of heterotopic ossification after traumatic brain injury. A review of current literature","volume":"86","author":"Anthonissen J","year":"2020","journal-title":"Acta Orthop Belg"},{"key":"e_1_2_14_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40141-020-00271-7"},{"key":"e_1_2_14_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2016.03.008"},{"key":"e_1_2_14_24_1","doi-asserted-by":"publisher","DOI":"10.3390\/jpm12071108"},{"key":"e_1_2_14_25_1","doi-asserted-by":"publisher","DOI":"10.2340\/16501977\u20101261"},{"key":"e_1_2_14_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clineuro.2014.05.013"},{"key":"e_1_2_14_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40141-016-0109-6"},{"key":"e_1_2_14_28_1","doi-asserted-by":"publisher","DOI":"10.1080\/10790268.2018.1465744"},{"issue":"2","key":"e_1_2_14_29_1","first-page":"1017","article-title":"Traumatic spinal cord injury with concomitant brain injury: in\u2010hospital complication rates and resource utilization","volume":"2","author":"Mansfield K","year":"2014","journal-title":"JSM Neurosurg Spine"},{"key":"e_1_2_14_30_1","doi-asserted-by":"publisher","DOI":"10.1097\/brs.0000000000002794"},{"key":"e_1_2_14_31_1","doi-asserted-by":"publisher","DOI":"10.3171\/2018.1.Spine171258"},{"key":"e_1_2_14_32_1","unstructured":"HansenL.IBM MarketScan Research Databases for life sciences researchers.2018IBM Watson Health."},{"key":"e_1_2_14_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-444-52137-8.00003-6"},{"key":"e_1_2_14_34_1","doi-asserted-by":"publisher","DOI":"10.2340\/16501977\u20100101"},{"key":"e_1_2_14_35_1","doi-asserted-by":"publisher","DOI":"10.1097\/htr.0000000000000153"},{"key":"e_1_2_14_36_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-199801000-00004"},{"key":"e_1_2_14_37_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlr.0000182534.19832.83"},{"key":"e_1_2_14_38_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.25653"},{"key":"e_1_2_14_39_1","doi-asserted-by":"publisher","DOI":"10.2147\/clep.S241610"},{"key":"e_1_2_14_40_1","doi-asserted-by":"publisher","DOI":"10.1186\/1472\u20106963\u201010\u2010140"},{"key":"e_1_2_14_41_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurpub\/cku221"},{"key":"e_1_2_14_42_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40621-015-0061-4"},{"key":"e_1_2_14_43_1","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2006.23.1450"},{"key":"e_1_2_14_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2013.08.299"},{"key":"e_1_2_14_45_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.PHM.0000073825.09942.8F"},{"key":"e_1_2_14_46_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.ss6609a1"},{"key":"e_1_2_14_47_1","doi-asserted-by":"publisher","DOI":"10.3390\/life14121657"},{"key":"e_1_2_14_48_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.PHM.0000078184.08835.01"},{"key":"e_1_2_14_49_1","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1989.00390080043011"},{"issue":"8","key":"e_1_2_14_50_1","first-page":"853","article-title":"Respiratory dysfunction and management in spinal cord injury","volume":"51","author":"Brown R","year":"2006","journal-title":"Respir Care"},{"key":"e_1_2_14_51_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41586-018-0595-z"},{"key":"e_1_2_14_52_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.expneurol.2016.08.018"},{"key":"e_1_2_14_53_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.resp.2009.08.003"},{"key":"e_1_2_14_54_1","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-323-91534-2.00012-6"},{"key":"e_1_2_14_55_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00408-021-00491-1"},{"key":"e_1_2_14_56_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.TA.0000071620.27375.BE"},{"key":"e_1_2_14_57_1","doi-asserted-by":"publisher","DOI":"10.1177\/0885066620972001"},{"key":"e_1_2_14_58_1","doi-asserted-by":"publisher","DOI":"10.21037\/jtd.2017.11.03"},{"key":"e_1_2_14_59_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.sc.3101298"},{"key":"e_1_2_14_60_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199412153312401"},{"key":"e_1_2_14_61_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.thromres.2020.10.041"},{"key":"e_1_2_14_62_1","doi-asserted-by":"crossref","unstructured":"Van Weert K Schouten EJ Hofstede J Meent H Holtslag HR van denBerg\u2010Emons R.Acute phase complications following traumatic spinal cord injury in Dutch level 1 trauma centres.2014;","DOI":"10.2340\/16501977-1858"},{"key":"e_1_2_14_63_1","doi-asserted-by":"publisher","DOI":"10.1080\/10790268.2020.1718265"},{"key":"e_1_2_14_64_1","doi-asserted-by":"publisher","DOI":"10.1089\/neu.2017.5403"},{"key":"e_1_2_14_65_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0277-9536(02)00236-8"},{"key":"e_1_2_14_66_1","unstructured":"National Spinal Cord Injury Statistical Center.Spinal Cord Injury Model Systems2023Annual Report.2023Accessed 5\/31\/2024.https:\/\/www.nscisc.uab.edu\/public\/AR2023_public%20version.pdf"},{"key":"e_1_2_14_67_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-022-07754-4"},{"key":"e_1_2_14_68_1","doi-asserted-by":"publisher","DOI":"10.1179\/107902611X12971826988057"},{"key":"e_1_2_14_69_1","doi-asserted-by":"publisher","DOI":"10.1179\/107902611X12971826988093"},{"key":"e_1_2_14_70_1","doi-asserted-by":"publisher","DOI":"10.1179\/107902611X12971826988174"},{"key":"e_1_2_14_71_1","doi-asserted-by":"publisher","DOI":"10.1179\/2045772312Y.0000000057"},{"key":"e_1_2_14_72_1","doi-asserted-by":"publisher","DOI":"10.1682\/JRRD.2006.12.0158"},{"key":"e_1_2_14_73_1","doi-asserted-by":"publisher","DOI":"10.1080\/026990596124368"},{"key":"e_1_2_14_74_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2008.07.008"},{"key":"e_1_2_14_75_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2014.10.028"},{"key":"e_1_2_14_76_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2018.12.037"},{"key":"e_1_2_14_77_1","doi-asserted-by":"publisher","DOI":"10.1038\/sc.2011.178"},{"key":"e_1_2_14_78_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2016.12.011"},{"key":"e_1_2_14_79_1","doi-asserted-by":"publisher","DOI":"10.1097\/PHM.0b013e31802f0247"},{"key":"e_1_2_14_80_1","doi-asserted-by":"publisher","DOI":"10.2340\/jrm.v54.2040"},{"key":"e_1_2_14_81_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12974-024-03177-6"},{"key":"e_1_2_14_82_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-023-04573-9"},{"key":"e_1_2_14_83_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.heliyon.2023.e12905"},{"key":"e_1_2_14_84_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-9993(99)90251-4"},{"key":"e_1_2_14_85_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.NPT.0000282247.15911.dc"},{"key":"e_1_2_14_86_1","doi-asserted-by":"publisher","DOI":"10.1038\/sc.2012.38"},{"key":"e_1_2_14_87_1","doi-asserted-by":"publisher","DOI":"10.1002\/j.2161-0045.2010.tb00190.x"},{"key":"e_1_2_14_88_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2016.06.012"},{"key":"e_1_2_14_89_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2021.02.030"},{"key":"e_1_2_14_90_1","doi-asserted-by":"publisher","DOI":"10.1038\/sj.sc.3101629"},{"key":"e_1_2_14_91_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2012.10.037"},{"key":"e_1_2_14_92_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.apmr.2022.01.162"}],"container-title":["PM&amp;R"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pmrj.13447","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/pmrj.13447","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/pmrj.13447","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T12:16:31Z","timestamp":1770984991000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/pmrj.13447"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,24]]},"references-count":91,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026,2]]}},"alternative-id":["10.1002\/pmrj.13447"],"URL":"https:\/\/doi.org\/10.1002\/pmrj.13447","archive":["Portico"],"relation":{},"ISSN":["1934-1482","1934-1563"],"issn-type":[{"value":"1934-1482","type":"print"},{"value":"1934-1563","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,24]]},"assertion":[{"value":"2024-09-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-05-23","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-24","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}