02292nas a2200229   4500000000100000008004100001100002000042700001700062700002800079700001800107700001600125700001700141700002000158700002000178700001800198700002200216700002300238700002400261245019200285520157100477022001402048       2018                            d1 aThompson Sandra1 aAtkins Emily1 aKatzenellenbogen Judith1 aHersh Deborah1 aCoffin Juli1 aFlicker Leon1 aHayward Colleen1 aCiccone Natalie1 aWoods Deborah1 aGreenland Melanie1 aMcAllister Meaghan1 aArmstrong Elizabeth00aMissing 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.3 a<p><b>OBJECTIVE: </b>To investigate differences in the profile and outcomes between Aboriginal and non-Aboriginal Western Australians (WAs) hospitalized with traumatic brain injury (TBI).</p><p><b>SETTING: </b>WA hospitals.</p><p><b>PARTICIPANTS: </b>TBI cases aged 15 to 79 years surviving their first admission during 2002-2011.</p><p><b>DESIGN: </b>Patients identified from diagnostic codes and followed up for 12 months or more using WA-wide person-based linked hospital and mortality data.</p><p><b>MAIN MEASURES: </b>Demographic profile, 5-year comorbidity history, injury mechanism, injury severity, 12-month readmission, and mortality risks. Determinants of 12-month readmission.</p><p><b>RESULTS: </b>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.</p><p><b>CONCLUSION: </b>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.</p>  a1550-509X