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).
J Head Trauma Rehabil. 2018 Nov/Dec;33(6):412-423. doi: 10.1097/HTR.0000000000000371.
To investigate differences in the profile and outcomes between Aboriginal and non-Aboriginal Western Australians (WAs) hospitalized with traumatic brain injury (TBI).
WA hospitals.
TBI cases aged 15 to 79 years surviving their first admission during 2002-2011.
Patients identified from diagnostic codes and followed up for 12 months or more using WA-wide person-based linked hospital and mortality data.
Demographic profile, 5-year comorbidity history, injury mechanism, injury severity, 12-month readmission, and mortality risks. Determinants of 12-month readmission.
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.
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.
调查在西澳大利亚州（WA）因创伤性脑损伤（TBI）住院的原住民和非原住民患者在特征和结局方面的差异。
WA 医院。
2002-2011 年间首次入院时存活的 15 至 79 岁 TBI 患者。
根据诊断代码识别患者，并通过 WA 范围内基于人员的医院和死亡率数据进行 12 个月或更长时间的随访。
人口统计学特征、5 年合并症史、损伤机制、损伤严重程度、12 个月再入院和死亡率风险。12 个月再入院的决定因素。
在 16601 例 TBI 幸存者中，14%为原住民。原住民患者更可能为女性、居住在偏远地区且合并症更多。损伤机制在 57%的原住民患者中为攻击（vs 20%），在 33%的非原住民患者中为交通伤（vs 17%），这取决于偏远程度。十分之一的原住民 TBI 患者未经医嘱擅自出院。原住民 TBI 患者的 12 个月再入院率较高（48% vs 36%），但死亡率无显著差异。年龄、性别和损伤机制对原住民和非原住民患者 12 个月再入院的影响不同。
这些发现表明迫切需要多部门共同预防 TBI，并需要提供文化安全且符合实际的医疗和康复服务交付模式，以优化结局。
