Missing voices: Profile, extent, and 12-month outcomes of nonfatal traumatic brain injury in aboriginal and non-aboriginal adults in Western Australia using linked administrative records
Katzenellenbogen JM., Atkins E., Thompson SC., Hersh D., Coffin J., Flicker L., Hayward C., Ciccone N., Woods D., Greenland ME., McAllister M., Armstrong EM.
Objective: To investigate differences in the profile and outcomes between Aboriginal and non-Aboriginal Western Australians (WAs) hospitalized with traumatic brain injury (TBI). Setting: WA hospitals. Participants: TBI cases aged 15 to 79 years surviving their first admission during 2002-2011. Design: Patients identified from diagnostic codes and followed up for 12 months or more using WA-wide person-based linked hospital and mortality data. Main Measures: Demographic profile, 5-year comorbidity history, injury mechanism, injury severity, 12-month readmission, and mortality risks. Determinants of 12-month readmission. Results: Of 16 601 TBI survivors, 14% were Aboriginal. Aboriginal patients were more likely to be female, live remotely, and have comorbidities. The mechanism of injury was an assault in 57% of Aboriginal patients (vs 20%) and transport in 33% of non-Aboriginal patients (vs 17%), varying by remoteness. One in 10 Aboriginal TBI patients discharged themselves against medical advice. Crude 12-month readmission but not mortality risk was significantly higher in Aboriginal patients (48% vs 36%). The effect of age, sex, and injury mechanism on 12-month readmission was different for Aboriginal and non-Aboriginal patients. Conclusion: These findings suggest an urgent need for multisectoral primary prevention of TBI, as well as culturally secure and logistically appropriate medical and rehabilitation service delivery models to optimize outcomes.