Traumatic Brain Injury-Related Emergency Department Visits Among American Indian and Alaska Native Persons-National Patient Information Reporting System, 2005-2014.

The data cover only people who use Indian Health Service or tribally managed facilities, not all American Indian and Alaska Native people. The paper says about 2.6 million people access Indian Health Service services, while 5.2 million self-reported as American Indian or Alaska Native in the US census. The Western region was excluded because of missing facility and contract health services data. Cells with fewer than 5 observations were suppressed, so small groups may not be visible. Mechanism of injury came from billing and external cause codes, which may not fully reflect how injuries occurred. The records may not capture sites without compatible electronic health records. The paper reports emergency department visits; it does not say how many separate people were seen, and it does not report injury severity, rehabilitation needs, or patient outcomes. The authors say the data cannot show whether increases reflect true injury incidence, care-seeking behavior, or other unexamined reasons.

The authors declare no conflict of interest.

Do not read the rise in emergency department visits as proof that traumatic brain injury became more common. The authors state the data cannot separate a true change in injury incidence from changes in care-seeking behavior or other unexamined reasons.