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A Multicenter Analysis on the Effect of the US-Mexico Border Wall Extension on Neurological Trauma. BACKGROUND AND OBJECTIVES: The California-Mexico border wall height extension has been associated with increased rates of traumatic injuries. We sought to determine whether the US-Mexico border wall fortifications are associated with increased rates and severity of neurological injuries after falls and increased hospital resource utilization across the Southwestern border. METHODS: Patients who presented to UC San Diego, Banner University of Arizona, or South Texas Health System trauma center after a fall from the US-Mexico border wall between 2016 and 2022 were identified and categorized as "preheight extension" or "postheight extension." Patient demographic information, injury characteristics, and neurosurgical interventions were recorded. Univariable and multivariable analyses were performed to determine the impact of patient factors on outcomes. RESULTS: A total of 304 patients with 331 neurological injuries were included. Injuries grew 556% from 18 in 2016 to 118 in 2022. The preheight extension cohort comprised 52 patients (median age 29 years, 60% male), whereas the postheight extension cohort comprised 252 patients (median age 30 years, 66% male). On a per-month basis, there were significantly more spinal (0.36 vs 1.77, P < .001) and traumatic brain injuries (0.09 vs 0.33, P < .001) in the postheight extension cohort. The number of neurological injuries (0.43 vs 1.91, P < .001) and operative injuries per month (0.13 vs 0.61, P < .001) also increased. Postheight extension patients had greater hospital lengths of stay (6 vs 8 days, P < .001) and charges ($92 825 vs $221 613, P < .001). Using a Poisson regression model adjusted for sites and border apprehensions, the number of neurological injuries was 0.51 (95% CI [0.22-0.94], P = .02) per month higher in the postheight extension cohort. CONCLUSION: The US-Mexico border wall height extension is associated with a significant rise in neurological injuries and morbidity for immigrants, and an increase in hospital resource utilization. We hope these consequences are taken into consideration in future border policy decisions.