OBJECTIVE To compare Veterans Administration (VA) 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 (CENC) multicenter observational study. DESIGN Prospective Cohort Study. SETTING 4 VA Medical Centers (VAMCs). PARTICIPANTS OEF/OIF/OND veterans who utilized VAMCs services between 2002-2017. INTERVENTIONS Not applicable. Lifetime mTBI history was assessed via semi-structured interviews. MAIN OUTCOME MEASURES VA diagnoses, health services utilization and costs. RESULTS Relative to NBR mTBI and no mTBI, veterans with BR mTBI were more likely to be male, have greater combat, 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 (PTSD) and anxiety diagnoses. Veterans with BR had the highest site adjusted mean annual VHA utilization (26.31 visits; 95% 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 ($6,480; 95% CI $5,842:$7,187), relative to NBR ($4,901; 95% CI $4,392:$5,468), and no mTBI ($4,069; 95% CI $3,404:$4,864). CONCLUSIONS 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.

中文翻译：

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卫生服务利用、医疗费用和轻度创伤性脑损伤诊断：神经创伤联盟 (CENC) 研究的慢性影响

目的 比较手术中轻度创伤性脑损伤 (mTBI) 组（爆炸相关 (BR) mTBI 与非爆炸相关 (NBR) mTBI 与无 mTBI）的退伍军人管理局 (VA) 诊断、卫生服务利用率和费用持久自由 (OEF)/伊拉克自由行动 (OIF)/新黎明行动 (OND) 退伍军人参与神经创伤联盟 (CENC) 多中心观察性研究的慢性影响。设计前瞻性队列研究。设置 4 VA 医疗中心 (VAMC)。参与者 2002 年至 2017 年间使用 VAMC 服务的 OEF/OIF/OND 退伍军人。干预措施 不适用。通过半结构化访谈评估终生 mTBI 病史。主要成果衡量 VA 诊断、卫生服务利用率和成本。结果 相对于 NBR mTBI 和无 mTBI，患有 BR mTBI 的退伍军人更有可能是男性，战斗力更强，受控和非受控爆炸暴露（中位 BR=15.0 vs NBR=3.0 vs 无 mTBI=3.0）。他们的头痛、创伤后应激障碍（PTSD）和焦虑症的患病率也较高。相对于 NBR（20.43 次就诊；95% CI 20.15:20.71），患有 BR 的退伍军人的现场调整平均年 VHA 使用率最高（26.31 次就诊；95% CI 26.01:26.61），并且没有 mTBI（16.62 次就诊；95% CI 16.21） ：17.04），相对于 NBR（4,901 美元；95% CI $4,392：5,468 美元），地点调整后平均年度 VHA 门诊费用最高（6,480 美元；95% CI $5,842：7,187 美元），无 mTBI（4,069 美元；95% CI $3,404：4,864 美元） ）。结论 患有 BR mTBI 的退伍军人更容易接触战斗和爆炸。相对于 NBR 和非 mTBI，BR 与更高的选择性诊断患病率以及更高的卫生服务利用率和成本相关。