Head injury and 25-year risk of dementia.

INTRODUCTION: Head injury is associated with significant morbidity and mortality. Long-term associations of head injury with dementia in community-based populations are less clear. METHODS: Prospective cohort study of 14,376 participants (mean age 54 years at baseline, 56% female, 27% Black, 24% with head injury) enrolled in the Atherosclerosis Risk in Communities (ARIC) Study. Head injury was defined using self-report and International Classification of Diseases, Ninth/Tenth Revision (ICD-9/10) codes. Dementia was defined using cognitive assessments, informant interviews, and ICD-9/10 and death certificate codes. RESULTS: Head injury was associated with risk of dementia (hazard ratio [HR] = 1.44, 95% confidence interval [CI] = 1.3-1.57), with evidence of dose-response (1 head injury: HR = 1.25, 95% CI = 1.13-1.39, 2+ head injuries: HR = 2.14, 95% CI = 1.86-2.46). There was evidence for stronger associations among female participants (HR = 1.69, 95% CI = 1.51-1.90) versus male participants (HR = 1.15, 95% CI = 1.00-1.32), P-for-interaction < .001, and among White participants (HR = 1.55, 95% CI = 1.40-1.72) versus Black participants (HR = 1.22, 95% CI = 1.02-1.45), P-for-interaction = .008. DISCUSSION: In this community-based cohort with 25-year follow-up, head injury was associated with increased dementia risk in a dose-dependent manner, with stronger associations among female participants and White participants.

Racial Disparities in Diagnosis of Concussion and Minor Head Trauma and Mechanism of Injury in Pediatric Patients Visiting the Emergency Department.

OBJECTIVE: To determine if racial/ethnic differences exist in the diagnosis and mechanism of injury among children and adolescents visiting the emergency department (ED) for concussion and minor head trauma (MHT). STUDY DESIGN: A retrospective, cross-sectional study of patient (age ≤19 years) visits to the ED for concussion between 2010-2015, using the National Hospital Ambulatory Medical Care Survey, was completed. The primary study exposure was race/ethnicity. Outcome measures included ED visits that resulted in a concussion/MHT diagnosis and mechanism of injury. Mechanism categories included sport, motor vehicle collision, fall, assault, and other mechanism. A multivariable logistic regression and multinomial logistic regression were conducted to assess relationships between race/ethnicity and outcomes. Findings were weighted to reflect population estimates. RESULTS: In total, 1263 child/adolescent visits for concussion/MHT were identified, representing an estimated 6.6 million child/adolescent visits nationwide. Compared with non-Hispanic White pediatric patients, non-Hispanic Black patients were least likely to have an ED visit for a concussion/MHT (P < .001; OR, 0.66; 95% CI, 0.52-0.83) The odds of non-Hispanic Black children/adolescents (OR, 3.80; 95% CI, 1.68-8.55) and children/adolescents of other race/ethnicity (OR, 4.93; 95% CI, 1.09-22.23) sustaining a concussion/MHT resulting from assault vs sport was higher. CONCLUSIONS: Amid the emerging focus on sport-related concussion, these ethnic/racial differences in ED diagnosis of concussion/MHT demonstrate sociodemographic differences that warrant further attention. Assault may be a more common mechanism of concussion among children/adolescents of a racial minority.

Violence in the first millennium BCE Eurasian steppe: Cranial trauma in three Turpan Basin populations from Xinjiang, China.

OBJECTIVES: Violence affected daily life in prehistoric societies, especially at conflict zones where different peoples fought over resources and for other reasons. In this study, cranial trauma was analyzed to discuss the pattern of violence experienced by three Bronze to early Iron Age populations (1,000-100 BCE) that belonged to the Subeixi culture. These populations lived in the Turpan Basin, a conflict zone in the middle of the Eurasian Steppe. METHODS: The injuries on 129 complete crania unearthed from the Subeixi cemeteries were examined for crude prevalence rate (CPR), trauma type, time of occurrence, possible weapon, and direction of the blow. Thirty-three injuries identified from poorly preserved crania were also included in the analyses except for the CPR. Data was also compared between the samples and with four other populations that had violence-related backgrounds. RESULTS: Overall, 16.3% (21/129) of the individuals showed violence-induced traumatic lesions. Results also indicated that most of the injuries were perimortem (81.6%), and that women and children were more involved in conflict than the other comparative populations. Wounds from weapons accounted for 42.1% of the identified cranial injuries. Distribution analysis suggested no dominant handedness of the attackers, and that blows came from all directions including the top (17.1%). Wounds caused by arrowheads and a special type of battle-ax popular in middle and eastern Eurasian Steppe were also recognized. DISCUSSION: A comprehensive analysis of the skeletal evidence, historical records, and archeological background would suggest that the raiding to be the most possible conflict pattern reflected by the samples. The attackers were likely to have been nomadic invaders from the steppe (such as the Xiongnu from historical records), who attacked the residents in the basin more likely for their resources rather than territory or labor force.

Motorcycle-related head and neck injuries: increased risk among ethnic minorities.

BACKGROUND: Ethnic disparities have been associated with injury and mortality. The impact of ethnicity on head and neck injury (HNI), traumatic brain injury (TBI), in-hospital mortality and resource utilization following a motorcycle crash (MCC) is undetermined. This study explored the influence of ethnicity in these aspects and the effect of helmet use on HNI and TBI following a MCC. METHODS: The National Trauma Registry provided hospitalization data on motorcycle riders and passengers between 2008 and 2017. Ethnicity was classified as Jews or Arabs, the two major ethnic groups in Israel. Univariate followed by multivariable logistic models were applied to examine ethnic disparities. Mediation effect was tested by structural equation modeling. RESULTS: Among 6073 MCC casualties, Arabs had increased odds of HNI (OR = 1.37,95% CI = 1.12-1.65) and TBI (OR = 1.51,95%CI = 1.12-1.99), and a six-fold decreased odds of helmet use (OR = 0.16,95%CI = 0.12-0.22). The HNI and TBI associations with ethnicity were mediated by helmet use. Arabs had significantly higher odds for admission to intensive care unit (OR = 1.36,95%CI = 1.00-1.83), and lower odds for ambulance evacuation (OR = 0.73,95%CI = 0.61-0.89) and discharge to rehabilitation (OR = 0.55,95%CI = 0.39-0.7). In-hospital mortality was not associated with ethnicity. CONCLUSIONS: Helmet non-use is an important etiologic factor associated with motorcycle-related HNI and TBI among Arabs. While in Israel, ethnic equality exists in in-hospital health care, disparities in ambulance and rehabilitation utilization was found. Intervention programs should target the Arab population and focus on helmet compliance.

Endemic violence in a pre-Hispanic Andean community: A bioarchaeological study of cranial trauma from the Majes Valley, Peru.

OBJECTIVES: This study examines violence-related cranial trauma frequencies and wound characteristics in the pre-Hispanic cemetery of Uraca in the lower Majes Valley, Arequipa, Peru, dating to the pre- and early-Wari periods (200-750 CE). Cranial wounds are compared between status and sex-based subgroups to understand how violence shaped, and was shaped by, these aspects of identity, and to reconstruct the social contexts of violence carried out by and against Uracans. MATERIALS AND METHODS: Presence, location, and characteristics (lethality, penetration, and post-traumatic sequelae) of antemortem and perimortem cranial fractures are documented for 145 crania and compared between subgroups. Cranial wounds are mapped in ArcGIS and the locational distribution of injuries is compared between male and female crania. RESULTS: Middle adult males were disproportionately interred at Uraca, particularly in the elite Sector I. The Uraca mortuary population presents the highest rate of cranial trauma reported for pre-Hispanic Peru: 67% of adults present trauma, and among those, 61.1% present more than one cranial injury. Males exhibit significantly more cranial trauma than females and present a higher mean number of injuries per person. Elite males show the highest mean number of injuries per person, more antemortem injuries, and are the only ones with perimortem cranial trauma, bladed injuries, penetrating injuries, and post-traumatic sequelae. Both sexes were most frequently injured on the anterior of the cranium, while the proportion of posterior injuries was higher for females. DISCUSSION: The rate, intensity, and locational patterns of cranial trauma suggests the community was engaged in raids and/or war with enemy groups, some of which may have increased physical violence between community members. Engaging in violence was likely a prerequisite for burial in the elite sector and was bound up with the generation and maintenance of social status differences linked to male social life.

Racial and Ethnic Disparities and Bias in the Evaluation and Reporting of Abusive Head Trauma.

OBJECTIVE: To characterize racial and ethnic disparities in the evaluation and reporting of suspected abusive head trauma (AHT) across the 18 participating sites of the Pediatric Brain Injury Research Network (PediBIRN). We hypothesized that such disparities would be confirmed at multiple sites and occur more frequently in patients with a lower risk for AHT. STUDY DESIGN: Aggregate and site-specific analysis of the cross-sectional PediBIRN dataset, comparing AHT evaluation and reporting frequencies in subpopulations of white/non-Hispanic and minority race/ethnicity patients with lower vs higher risk for AHT. RESULTS: In the PediBIRN study sample of 500 young, acutely head-injured patients hospitalized for intensive care, minority race/ethnicity patients (n = 229) were more frequently evaluated (P < .001; aOR, 2.2) and reported (P = .001; aOR, 1.9) for suspected AHT than white/non-Hispanic patients (n = 271). These disparities occurred almost exclusively in lower risk patients, including those ultimately categorized as non-AHT (P = .001 [aOR, 2.4] and P = .003 [aOR, 2.1]) or with an estimated AHT probability of ≤25% (P <.001 [aOR, 4.1] and P <.001 [aOR, 2.8]). Similar site-specific analyses revealed that these results reflected more extreme disparities at only 2 of 18 sites, and were not explained by local confounders. CONCLUSION: Significant race/ethnicity-based disparities in AHT evaluation and reporting were observed at only 2 of 18 sites and occurred almost exclusively in lower risk patients. In the absence of local confounders, these disparities likely represent the impact of local physicians' implicit bias.

Interpersonal violence among the Chalcolithic and Bronze Ages inhabitants living on the Central Plateau of Iran: A voice from Tepe Hissar.

ABSTRACT: The site of Tepe Hissar (Iran) experienced widespread cultural and economic changes during the Chalcolithic and Bronze Ages (5th to the 2nd millennium B.C.). The discovery of evidence of burning, including charred human remains, the destruction of buildings (Periods II and III), and the presence of several mass-burials with comingling of human skeletal remains consisting of ten or more individuals (Period III), suggests interpersonal violence during these periods. The original excavator of Tepe Hissar, Erich Schmidt, suggested that phenomena such as war, massacres, epidemics, or similar catastrophes, may have been responsible for the excavated archaeological evidence. This study tests the hypothesis that interpersonal violence was responsible for this evidence. Patterns of violence related head injury are explored among 129 adult men and women from the Chalcolithic and Bronze Ages. Sixty of the 129 (46.5%) crania examined presented with cranial trauma, with 25 (19.3%) having evidence of perimortem injury, and four (3.1%) and 31 (24%) individuals with signs of healing and healed head/facial trauma, respectively. Most of the injuries were located on the frontal or parietal bones of the cranium. Such findings may be interpreted as a result of the population experiencing a rise in social complexity and population increase that accompanied violence related to intra- or inter-group competition, often leading to lethal outcomes. These data support the hypothesis that the cultural and economic transitions and population changes that occurred at Tepe Hissar, and particularly in the Hissar II and III periods, were accompanied by tension and interpersonal violence.

Fall-related hospitalisations of older Aboriginal and Torres Strait Islander people and other Australians.

OBJECTIVES: To compare the socio-demographic characteristics and type of injury sustained, the use of hospital resources and rates of hospitalisation by injury type, and survival following fall injuries to older Aboriginal people and non-Indigenous Australian people hospitalised for fall-related injuries. DESIGN: Population-based retrospective cohort data linkage study. Setting, participants: New South Wales residents aged 50 years or more admitted to a public or private NSW hospital for a fall-related injury during 1 January 2003 - 31 December 2012. MAIN OUTCOME MEASURES: Proportions of patients with defined injury types, mean hospital length of stay (LOS), 30-day mortality, age-standardised hospitalisation rates and age-adjusted rate ratios, 28-day re-admission rates. RESULTS: There were 312 758 fall-related injury hospitalisations for 234 979 individuals; 2660 admissions (0.85%) were of Aboriginal people. The proportion of hospitalisations for fall-related fracture injuries was lower for Aboriginal than for non-Indigenous Australians (49% v 60% of fall-related hospitalisations; P < 0.001). The major injury type for Aboriginal patients was non-fracture injury to head or neck (19% of hospitalisations); for non-Indigenous patients it was hip fractures (18%). Age-adjusted LOS was lower for Aboriginal than for non-Indigenous patients (9.1 v 14.0 days; P < 0.001), as was 30-day mortality (2.9% v 4.2%; P < 0.001). For Aboriginal people, fall injury hospitalisations increased at an annual rate of 5.8% (95% CI, 4.0-7.7%; P < 0.001); for non-Indigenous patients, the mean annual increase was 2.5% (95% CI, 2.1-3.0; P < 0.001). CONCLUSIONS: The patterns of injury and outcomes of fall injury hospitalisations were different for older Aboriginal people and other older Australians, suggesting that different approaches are required to prevent and treat fall injuries.

Racial Disparities in Cranial Gunshot Wounds: Intent and Survival.

BACKGROUND: Gunshot wounds (GSW) to the head are associated with the highest mortality of all gun-related injuries, with assault reported as the leading cause of penetrating GSW. Several studies have explored factors and trends related to assault and self-inflicted GSW separately. The aim of this study was to investigate epidemiological characteristics and racial differences collectively in patients with GSW to the head by examining associations to injury intent and survival. METHOD: A retrospective study was performed by accessing the hospital trauma registry at our regional Level 1 Trauma Center. A query of neurosurgery consults with penetrating trauma was completed from January 2008 to October 2013. Patients with penetrating intracranial GSW were included in the study. A chi-square test was used to evaluate association between patients' characteristics and intent of injury. Logistic regression analyses predicting intent of injury and survival were also conducted. RESULTS: Of 111 patients, the majority were male (87.4 %). Most were African American (57.7 %) and Caucasian (35.1 %). Compared to African Americans, Caucasian patients were more likely to inflict self-harm (odds ratio (OR) 16.369 (95 % confidence interval (CI) 5.633-47.571), p < 0.0001), while African Americans (OR 26.413 (95 % CI 8.957-77.890), p < 0.0001) were more likely to be victims of assault. Race and other demographic variables did not predict survival nor did intent of injury (p = 0.368). CONCLUSION: This study reports that there are racial disparities between assault GSW and self-inflicted GSW. However, neither race nor intent is a predictor of survival outcome. Targeted efforts are needed to reduce occurrence of cranial GSW events in order to decrease associated morbidity and mortality.

Racial/ethnic and socioeconomic disparities in the use of helmets in children involved in bicycle accidents.

PURPOSE: While bicycle helmet use reduces bicycle-related head injury, few children wear them regularly. We aimed to describe racial/ethnic and socioeconomic differences in pediatric helmet use in Los Angeles County (LAC) to help target groups for injury prevention programs. METHODS: A retrospective review of all pediatric patients involved in bicycle-related accidents in LAC between 2006 and 2011 was performed. Our primary analysis examined the association between helmet use and age, gender, insurance status, and race/ethnicity. We also evaluated the association between helmet use and the need for emergency surgery, mortality, and length of hospital stay (LOH), after adjusting for injury severity score (ISS), age, insurance status, and race/ethnicity. RESULTS: Of 1248 patients, 11.3% wore helmets, with decreased use among children 12years and older, minorities, and those without private insurance. Overall, 5.9% required an emergency operation, 34.1% returned to their pre-injury capacity, and mortality was 0.7%. On multivariable analysis, higher ISS increased LOH, the risk for emergency surgery, and mortality. CONCLUSION: Nearly 90% of children involved in bicycle-related accidents were not wearing helmets. Helmet use was lower among older children, minorities, and those from a low socioeconomic status. Injury prevention programs targeting low-income middle and high schools and minority communities may help increase helmet use in children in LAC.

Ethnic disparities in trauma mortality outcomes.

BACKGROUND: Ethnic disparities in trauma mortality outcomes have been demonstrated in the United States according to the US National Trauma Data Bank. The aim of this study was to determine the effect of race/ethnicity on trauma mortality in Singapore. METHODS: This was a retrospective review of patients aged 18-64 years with an injury severity score (ISS) ≥ 9 in the Trauma Registry of Tan Tock Seng Hospital, a 1,300-bed trauma center in Singapore, from 2006 to 2010. Chinese, Malay, and Indian patients were compared with patients of other ethnic groups. Multiple logistic regression analyses determined differences in survival rates after adjusting for demographics, anatomic and physiologic ISS and revised trauma score, mechanism or type of injury. RESULTS: A total of 4,186 patients (66.4 % of the database) met the inclusion criteria. Most patients were male (76.3 %) and young (mean age 40 years). Using Chinese as the reference group, we found no statistically significant differences in unadjusted or adjusted mortality rates among the ethnic groups. Independent predictors of mortality included age [odds ratio (OR) 1.05, 95 % confidence interval (CI) 1.03-1.06, p < 0.0001], presence of severe head injury (OR 1.75, 95 % CI 1.13-2.69, p = 0.012), and increasing ISS (p < 0.0001). CONCLUSIONS: Ethnicity is not an independent predictor of trauma mortality outcomes in the Singapore population. Our findings contrast with those from the United States, where race/ethnicity (Black and Hispanic) remains a strong independent risk factor for trauma mortality. This study attests to the success of the Singapore health care/trauma system in delivering the same quality of care regardless of ethnicity.

Temporal factors in violence related injuries--An 11 year trend analysis of violence-related injuries from a Swiss Emergency Department.

BACKGROUND: Injury from interpersonal violence is a major social and medical problem in the industrialized world. Little is known about the trends in prevalence and injury pattern or about the demographic characteristics of the patients involved. METHODS: In this retrospective analysis, we screened the database of the Emergency Department of a large university hospital for all patients who were admitted for injuries due to interpersonal violence over an 11 year period. For all patients identified, we gathered data on age, country of origin, quality of injury, and hospitalization or outpatient management. A trend analysis was performed using Kendall's tau-b correlation coefficients for regression analysis. RESULTS: The overall number of patients admitted to our Emergency Department remained stable over the study period. Non-Swiss nationals were overrepresented in comparison to the demographics of the region where the study was conducted. There was a trend toward a more severe pattern of injury, such as an increase in the number of severe head injuries. CONCLUSIONS: Although the overall number of patients remained stable over the study period, there was an alarming trend toward a more severe pattern of injury, expressed by an increase in severe head traumas.

Suboptimal anti-epilepsy drug use is common among indigenous patients with seizures presenting to the emergency department.

We aimed to explore the causes of higher than expected rates of Indigenous emergency department (ED) seizure presentations. A questionnaire was administered to adult patients presenting with seizure to an ED in Far North Queensland. Over 15 months, among 260 presentations with seizure (22% Indigenous), 50% non-Indigenous patients, and 45% Indigenous patients completed the questionnaire. Risk factors for alcohol misuse were common in both groups (50% Indigenous, 43% non-Indigenous; p = 0.50), as were rates of reported head injury (50% Indigenous, 44% non-Indigenous; p = 0.50). However, 47% Indigenous patients, compared to 19% non-Indigenous patients (p < 0.05) reported missing anti-epileptic tablets at least twice weekly, representing clinically relevant medication non-adherence. This was the first reported seizure presentation for 12% Indigenous patients and 26% non-Indigenous patients. We conclude that among ED seizure presentations, alcohol excess and prior head injury are commonly observed, in both Indigenous and non-Indigenous patients. However, Indigenous patients have higher rates of anti-convulsant non-adherence, likely contributing to ED presentations.

Predictors of positive head CT scan and neurosurgical procedures after minor head trauma.

BACKGROUND: There continues to be an ongoing debate regarding the utility of head CT scans in patients with a normal Glasgow Coma Scale (GCS) after minor head injury. The objective of this study is to determine patient and injury characteristics that predict a positive head CT scan or need for a neurosurgical procedure (NSP) among patients with blunt head injury and a normal GCS. MATERIALS AND METHODS: Retrospective analysis of adult patients in the National Trauma Data Bank who presented to the ED with a history of blunt head injury and a normal GCS of 15. The primary outcomes were a positive head CT scan or a NSP. Multivariate logistic regression controlling for patient and injury characteristics was used to determine predictors of each outcome. RESULTS: Out of a total of 83,566 patients, 24,414 (29.2%) had a positive head CT scan and 3476 (4.2%) underwent a NSP. Older patients and patients with a history of fall (compared with a motor vehicle crash) were more likely to have a positive finding on a head CT scan. Male patients, African-Americans (compared with Caucasians), and those who presented with a fall were more likely to have a NSP. CONCLUSIONS: Older age, male gender, ethnicity, and mechanism of injury are significant predictors of a positive finding on head CT scans and the need for neurosurgical procedures. This study highlights patient and injury-specific characteristics that may help in identifying patients with supposedly minor head injury who will benefit from a head CT scan.

Neuroimaging for pediatric head trauma: do patient and hospital characteristics influence who gets imaged?

OBJECTIVES: The objective was to identify patient, provider, and hospital characteristics associated with the use of neuroimaging in the evaluation of head trauma in children. METHODS: This was a cross-sectional study of children (< or =19 years of age) with head injuries from the National Hospital Ambulatory Medical Care Survey (NHAMCS) collected by the National Center for Health Statistics. NHAMCS collects data on approximately 25,000 visits annually to 600 randomly selected hospital emergency and outpatient departments. This study examined visits to U.S. emergency departments (EDs) between 2002 and 2006. Multivariable logistic regression was used to analyze characteristics associated with neuroimaging in children with head injuries. RESULTS: There were 50,835 pediatric visits in the 5-year sample, of which 1,256 (2.5%, 95% confidence interval [CI] = 2.2% to 2.7%) were for head injury. Among these, 39% (95% CI = 34% to 43%) underwent evaluation with neuroimaging. In multivariable analyses, factors associated with neuroimaging included white race (odds ratio [OR] = 1.5, 95% CI = 1.02 to 2.1), older age (OR = 1.3, 95% CI = 1.1 to 1.5), presentation to a general hospital (vs. a pediatric hospital, OR = 2.4, 95% CI = 1.1 to 5.3), more emergent triage status (OR = 1.4, 95% CI = 1.1 to 1.8), admission or transfer (OR = 2.7, 95% CI = 1.4 to 5.3), and treatment by an attending physician (OR = 2.0, 95% CI = 1.1 to 3.7). The effect of race was mitigated at the pediatric hospitals compared to at the general hospitals (p < 0.001). CONCLUSIONS: In this study, patient race, age, and hospital-specific characteristics were associated with the frequency of neuroimaging in the evaluation of children with closed head injuries. Based on these results, focusing quality improvement initiatives on physicians at general hospitals may be an effective approach to decreasing rates of neuroimaging after pediatric head trauma.

Epidemiology of injury and the impact of health disparities.

PURPOSE OF REVIEW: The purpose of this review is to highlight recent advances in understanding the epidemiology of pediatric trauma and the impact of health disparities on care of the injured child. RECENT FINDINGS: Recent studies examining outcomes for injury in children consistently demonstrate worse clinical and functional outcomes for minority children compared with white children, with African-American race being an independent predictor of mortality. Despite controlling for injury severity and insurance status (as a surrogate of socioeconomic status), these disparities persist. Significant racial differences in mortality were also identified when national data were compared with local institutional data for children with traumatic brain injury. Studies examining the effect of insurance status on care of the injured child have similarly uncovered unsettling inequities. Disparities in delivery of pediatric trauma care have been identified based on access to pediatric trauma centers. Other studies have sought to reduce disparities by use of guidelines. Finally, prevention studies have demonstrated racial disparities in the use of motor vehicle restraints, with improved restraint use in minority populations after implementation of culturally tailored prevention programs. SUMMARY: The cause of disparities in childhood trauma appears to be multifactorial and may include race, socioeconomic factors, insurance status, access, and healthcare provider biases. Multiple studies have confirmed that disparities exist, but it is difficult to tease out the reasons why they exist. Further work is necessary to identify causes of such disparities and formulate strategies to eliminate them.

Trends in head injury incidence in New Zealand: a hospital-based study from 1997/1998 to 2003/2004.

Traumatic brain injury (TBI) is a leading cause of disability and death in young adults. Globally, the incidence of TBI hospitalizations is estimated at 200-300 people per 100,000 annually. Using a national health database, we examined the incidence of TBI-related hospital discharges (including 1-day stays) to New Zealand Hospitals from 1997/1998 to 2003/2004. Crude annual hospital-based incidence rates for the total population ranged from 226.9 per 100,000 in 1998/1999 to a high rate of 349.2 in 2002/2003. There was a noticeable increase in rates with the change from ICD-9 to ICD-10 diagnostic codes and there was also disparity in incidence rates according to ethnicity, age and gender. Crude annual hospital-based incidence rates for males and females in Maori (689/100,000 and 302.8/100,000 person-years) and Pacific Island populations (582.6/100,000 and 217.6/100,000 person-years) were much higher than those for the remaining population (435.4/100,000 and 200.9/100,000 person-years), particularly for males. The overall age-standardized hospital- based incidence rate for 2003/2004 was 342 per 100,000 per year (95% CI = 337-349/100,000), and 458 per 100,000 per year for Maori (95% CI = 438-479/100,000) with Maori males experiencing a peak in incidence between 30 and 34 years of age that was not evidenced for the wider population. Standardized hospital-based incidence rates for the total population and for Maori by age, gender and ICD-10 diagnostic codes are also examined.

Despite overall low pediatric head injury mortality, disparities exist between races.

BACKGROUND: To continually improve quality of care, it is important for centers caring for children with head injury to evaluate their overall outcome and that among diverse patient groups. METHODS: Data on children with head injuries were extracted from the National Trauma Data Bank of the American College of Surgeons and our local trauma registry. Unadjusted mortality, as well as stratified analysis and logistic regression modeling, was used to evaluate overall and race-specific mortality. RESULTS: There were 13,363 children in the National Trauma Data Base and 3111 in our database included. Our overall mortality rate compared favorably with the national data (3.2% vs 6.8%, P < .05). Our local data, however, showed a significant difference in mortality between white and African American (AA) children (2.2% vs 5.3%, P < .05), which was not identified in the national data. After stratification, the disparities by race persisted. Finally, multivariate regression modeling revealed that AA race was an independent predictor of mortality among our patient population, with an odds ratio of 3.1 (95% confidence interval, 1.2-7.8). CONCLUSION: Despite excellent outcomes for children with head injuries, we have uncovered unsettling inequities between AA and white children. These findings support the need to evaluate outcomes among specific groups to identify disparities that require further careful investigation.

Hospitalisation for head injury due to assault among Indigenous and non-Indigenous Australians, July 1999--June 2005.

OBJECTIVE: To describe rates of hospitalisation for head injury due to assault among Indigenous and non-Indigenous Australians. DESIGN, SETTING AND PARTICIPANTS: Secondary analysis of routinely collected hospital morbidity data for 42,874 inpatients at public and private hospitals in Queensland, Western Australia, South Australia and the Northern Territory for the 6-year period 1 July 1999--30 June 2005. MAIN OUTCOME MEASURES: Rates per 100,000 population of head injury due to assault by Indigenous status, age, sex and location of residence. RESULTS: The overall rate of head injury due to assault was 60.4 per 100,000 population (95% CI, 59.8-60.9). The rate among the Indigenous population was 854.8 per 100,000 (95% CI, 841.0-868.9), 21 times that among the non-Indigenous population (40.7 per 100,000; 95% CI, 40.2-41.2). Most Indigenous (88%) and non-Indigenous (83%) victims of head injury due to assault were aged between 15 and 44 years. The peak incidence among the Indigenous population was in the 30-34-year age group, whereas that among the non-Indigenous population was in the 20-24-year age group. Indigenous females experienced 69 times the injury rate experienced by non-Indigenous females. CONCLUSIONS: Indigenous people, particularly women, were disproportionately represented among those hospitalised for head injury due to assault. Head injury imposes a substantial burden of care on individuals and communities. Along with the costs of treating head injury, these are good reasons to strengthen efforts to prevent head injury generally, with special attention to high-risk population segments.