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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, Judith M. PhD; Atkins, Emily PhD; Thompson, Sandra C. PhD; Hersh, Deborah PhD; Coffin, Juli PhD; Flicker, Leon PhD; Hayward, Colleen BEd; Ciccone, Natalie PhD; Woods, Deborah MSc; Greenland, Melanie E. MSc; McAllister, Meaghan BSpPath; Armstrong, Elizabeth M. PhD

Section Editor(s): Caplan, Bruce PhD, ABPP; Bogner, Jennifer PhD, ABPP; Brenner, Lisa PhD, ABPP; Malec, James PhD, ABPP

The Journal of Head Trauma Rehabilitation: November/December 2018 - Volume 33 - Issue 6 - p 412–423
doi: 10.1097/HTR.0000000000000371
Focus on Clinical Research and Practice

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.

School of Population and Global Health (Drs Katzenellenbogen, Atkins, and Thompson and Ms Greenland), Telethon Institute for Child Health Research (Drs Katzenellenbogen and Coffin), and Western Australian Centre for Health & Ageing, Centre for Medical Research (Dr Flicker), University of Western Australia, Perth, Australia; The George Institute for Global Health, University of New South Wales, Sydney, Australia (Dr Atkins); School of Medical and Health Sciences, Edith Cowan University, Perth, Australia (Drs Hersh, Ciccone, and Armstrong and Ms McAllister); Geraldton Regional Aboriginal Medical Service, Rangeway, Australia (Dr Coffin and Ms Woods); University of Notre Dame, Broome Campus, Broome, Australia (Dr Coffin); and Kurongkurl Katitjin Centre for Indigenous Australian Education and Research, Edith Cowan University, Mount Lawley, Australia (Ms Hayward).

Corresponding Author: Judith M. Katzenellenbogen, PhD, School of Population and Global Health, University of Western Australia, 35 Stirling Highway, Crawley, GPO Box U1987, Perth, WA 6009, Australia (

The authors wish to thank the staff at the Western Australian Data Linkage Branch, and the Department of Health Inpatient Data Collections and Registrar General for the provision of data.

This work was supported by the National Health and Medical Research Council of Australia (grant number 1046228). J.M.K. is funded by an Australian Heart Foundation Future Leader Fellowship (grant number 100807). The Western Australians Centre for Rural Health received funding from the Australian Government's Department of Health.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

The authors declare no conflicts of interest.

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