Background: Indigenous populations are disproportionately affected by traumatic brain injury (TBI). These populations rely on large jurisdiction surveillance efforts to inform their prevention strategies, which may not address their needs. This study describes the TBI determinants of a Quebec indigenous population, the Cree served by the Terres-Cries-de-la-Baie-James health region, and compares them to the determinants of two neighbouring health regions and the entire Province of Quebec. Methods: We conducted a retrospective population-based cohort study of incident TBI hospitalizations, stratified by the aforementioned health regions, in Quebec from 2000-2012. MED-éCHO administrative data were used for case finding. A sub-analysis of the Terres-Cries-de-la-Baie-James adults was completed to assess for determinants of TBI severity and outcomes. Regression models, multiple imputations and a sensitivity analysis were used to account for biased associations. Results: 172 incident TBI hospitalizations occurred in the Terres-Cries-de-la-Baie-James region from 2000-2012. The incidence rate was 92.1 per 100,000 person-years and the adjusted IRR was 1.86 (95% CI 1.56-2.17) when compared to the entire province. Determinants of TBI for the Terres-Cries-de-la-Baie-James were significantly different from those of neighboring populations and the entire province. Conclusions: TBI surveillance information from large jurisdiction initiatives can be misleading for indigenous communities. Community-based surveillance provides evidence that these populations should use to prioritize prevention strategies.