The silent minority: Insights into who fails to present for medical care following a brain injury

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Background: The WHO and Center for Disease Control have identified that current estimates of brain injury incidence miss individuals who do not seek medical attention for their injury. Methods: The Canadian Community Health Survey is a nationally representative health survey. Respondents aged 12 years and above reporting “concussion or other brain injury” occurring within the previous year also reported whether they had received any medical attention from a health professional within 48 h of their injury. Results: Nationally representative data were available biennially from 2000/2001 through 2013/2014 with the exception of 2007/2008 and 2011/2012. In all, 1,749 respondents reported concussion or other brain injury with disability in the previous 12 months. Of these, 21.9% (95% CI 19.0-24.7) reported not having received medical attention from a health professional within 48 h following their injury. Within a multivariable model, those who are more likely not to receive medical care with 48 h of incurring a brain injury are more likely to be younger (<20 years) or older (>24 years), have an injury incurred through sports exposure or in or around their home, do not identify as immigrant, and are currently smokers. The area under the ROC was modest at 0.58. Conclusions: Within a nationally representative sample of individuals reporting concussion or other brain injury, we found that those reporting medical non-attendance and those reporting medical attendance within 48 h of their injury were remarkably similar. This outcome suggests that brain injury surveillance based on point of care may produce relatively unbiased samples of the brain injured population.