US Department of Defense
Advancing Blast Injury Research to Protect and Heal Those Who Serve

An Observational Study of the Impact of Mild TBI on Health Care Services, Costs, and Diagnoses

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Active duty and reserve Service members are at an increased risk for traumatic brain injury (TBI) when compared to the civilian population. The prevalence of TBI diagnosis in Service members since 2000 ranges from about four to ten percent. Furthermore, Service members increasingly have been exposed to environments in which they are at a higher risk for exposure to blast events which could cause a TBI. Accordingly, many Veterans continue to seek treatment for symptoms from TBI, and previous research suggests that those with diagnosed TBI have higher health services utilization and costs than those without TBI diagnoses. Comorbid diagnoses common in TBI such as headache, post-traumatic stress disorder (PTSD), and anxiety may contribute to some of these increased healthcare utilization costs. Administrative health care data does not, however, distinguish between TBI severity and source (i.e., blast versus blunt impact) and often combine TBI of all types, even though utilization and costs may differ for those with TBI with or without comorbid blast exposure. A recent study set out to investigate the association between mild TBI (mTBI) with and without comorbid blast exposure and the utilization and costs of healthcare services among Service members and Veterans1.

The study used participants enrolled in the Chronic Effects of Neurotrauma Consortium (CENC) longitudinal cohort study. Participants were restricted to those who had a record of Veterans Health Administration (VHA) outpatient health care utilization between 2002 and 2017 and the identifiers necessary to link CENC and VHA records; the prevalence of diagnoses was compared across mTBI history categories. Results of this analysis found that participants with a history of blast-related mTBI received more diagnoses of headache, (PTSD), and anxiety relative to participants with mTBI without blast exposure or no history of mTBI. Similarly, participants with a history of blast-related mTBI had the highest adjusted overall annual utilization of outpatient healthcare services, with similar patterns observed in the utilization of primary care, mental health, polytrauma/TBI, audiology, neurology, orthopedics, pain clinics, imaging, specialty care, other rehabilitation clinics, and otherwise non-classified visits. These results indicate that, while not universal across all healthcare specialty services, participants with a history of blast-related mTBI exhibited a higher prevalence of comorbidities (i.e., headache, PTSD, anxiety, etc.) and sought greater levels of healthcare services at a higher annual cost when compared to patients with mTBI without blast exposure or no history of mTBI.

The current study suggests that Veterans and Service members who have a history of blast-related mTBI would benefit from an interdisciplinary team of providers. It could also be expected that these findings would be associated with greater injury to more body regions and systems than mTBI alone, thereby increasing the clinical needs of this group. The study also found that those who suffer from mTBI unrelated to blast may have poorer access to VHA care due to factors such as reduced referrals to specialists due to provider perceptions of injury severity. Accordingly, it is recommended that future work monitors clinical outcomes among Veterans and Service members with a history of mTBI, both related and unrelated to blast, to distinguish between the comorbidities of TBI of various severities and mechanisms of injury. Likewise, it is important to monitor additional long-term outcomes to ensure that health care systems continue to provide the services needed.


1. Dismuke-Greer, C., Hirsch, S., Carlson, K., Pogoda, T., Nakase-Richardson, R., Bhatnagar, S., Eapen, B., Troyanskaya, M., Miles, S., Nolen, T., & Walker, W. C. (2020). Health Services Utilization, Health Care Costs, and Diagnoses by Mild Traumatic Brain Injury Exposure: A Chronic Effects of Neurotrauma Consortium Study. Archives of physical medicine and rehabilitation, 101(10), 1720–1730.


Supported by the U.S. Army Medical Research and Materiel Command [award no. W81XWH-13-2-0095] and the U.S. Department of Veterans Affairs Chronic Effects of Neurotrauma Consortium [VA Palo Alto Medical System, VA Project ID: RRDB-003-19S (SDR-20-030), eRA number l01 HX003155].

Last modified: 09-Feb-2021