Does Co-Occurring Traumatic Brain Injury Affect VHA Outpatient Health Service Utilization and Associated Costs Among Veterans With Posttraumatic Stress Disorder? An Examination Based on VHA Administrative Data.

The study used administrative diagnostic codes, not clinical review, so some veterans may have been misclassified or missed. TBI severity could not be reliably determined. Most participants could not be classified by the Barell matrix, and the severity analyses were preliminary. The data cover one fiscal year and focus on outpatient appointments and outpatient costs. Care outside VHA and veterans who did not seek VHA care were not included. Appointment counts from electronic records may not perfectly match actual clinical encounters because of documentation errors or omissions. The analysis did not separate the effect of TBI from other physical injuries, other mental health disorders, or pain diagnoses. The sample was very large, so small differences between groups could reach statistical significance. The actual appointment counts help judge whether a difference is important. The study design cannot show whether comorbid PTSD and TBI cause higher use or whether higher use leads to more diagnoses.

The authors declared no conflicts of interest.

Do not read the higher appointments and costs as proof that TBI causes more service use or that more treatment is needed. The study used one year of VHA administrative records and did not isolate the effect of TBI from other conditions.