Effect of Post-traumatic Amnesia Duration on Traumatic Brain Injury (TBI) First Year Hospital Costs: A Veterans Affairs Traumatic Brain Injury Model Systems Study

Objective: To examine the association between severity of traumatic brain injury (TBI) as measured by duration of post-traumatic amnesia (PTA) and first year hospitalization costs for service members and veterans (SMVs) treated for TBI at Polytrauma Rehabilitation Centers (PRCs) within the Veterans Health Administration (VHA).Design: Multivariable models of merged datasets from the VA TBI Model Systems (VA TBIMS) national database containing TBI clinical char-acterization including PTA with VHA hospital cost data.Setting: Five VA PRCs.Participants: VA TBIMS participants with known PTA who received inpatient rehabilitation within 1 year of their TBI at any of 5 PRCs between 2010 and 2020 (N=717).Interventions: N/A.Main Outcome Measures: Total, acute care, rehabilitation, intensive care unit (ICU), and surgery costs across all VA hospitals.Results: A total of 717 SMVs (mean age 36.9 years, 94.1% men, 76.8% non-Hispanic White, 7.8% active duty) met inclusion criteria for the unadjusted analyses. Unadjusted mean total hospital costs in the first-year post TBI were approximately $201,214 higher for those with PTA duration & GE;24 hours ($351,157) than PTA <24 hours ($149,943). In adjusted models (n=583), each additional day of PTA dura-tion incrementally increased total ($1453), rehabilitation ($1324), ICU ($78), and surgery ($39) costs. Other significant covariates included age, acute care length of stay, Disability Rating Scale on rehabilitation admission, penetrating violent cause of injury, and drug abuse.Conclusions: This study demonstrates that PTA as a quantitative measure of TBI severity significantly affects first-year hospitalization costs of SMVs treated at PRCs. Each additional day of PTA was associated with higher total, rehabilitation, ICU, and surgery costs. Mean first year hospi-tal costs were also found to exceed the highest budget allocation to VHA facilities for a veteran treated at a PRC. These findings have possible implications for hospital care provision for those receiving inpatient rehabilitation in VHA settings. Archives of Physical Medicine and Rehabilitation 2023;104:1007-15Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine.