Characteristics, clinical course, and outcomes of homeless and non-homeless patients admitted to ICU: A retrospective cohort study

Abstract

BackgroundLittle is known about homeless patients in intensive care units (ICUs).ObjectivesTo compare clinical characteristics, treatments, and outcomes of homeless to non-homeless patients admitted to four ICUs in a large inner-city academic hospital.Methods63 randomly-selected homeless compared to 63 age-, sex-, and admitting-ICU-matched non-homeless patients.ResultsCompared to matched non-homeless, homeless patients (average age 48±12 years, 90% male, 87% admitted by ambulance, 56% mechanically ventilated, average APACHE II 17) had similar comorbidities and illness severity except for increased alcohol (70% vs 17%,p<0.001) and illicit drug(46% vs 8%,p<0.001) use and less documented hypertension (16% vs 40%,p = 0.005) or prescription medications (48% vs 67%,p<0.05). Intensity of ICU interventions was similar except for higher thiamine (71% vs 21%,p<0.0001) and nicotine (38% vs 14%,p = 0.004) prescriptions. Homeless patients exhibited significantly lower Glasgow Coma Scores and significantly more bacterial respiratory cultures. Longer durations of antibiotics, vasopressors/inotropes, ventilation, ICU and hospital lengths of stay were not statistically different, but homeless patients had higher hospital mortality (29% vs 8%,p = 0.005). Review of all deaths disclosed that withdrawal of life-sustaining therapy occurred in similar clinical circumstances and proportions in both groups, regardless of family involvement. Using multivariable logistic regression, homelessness did not appear to be an independent predictor of hospital mortality.ConclusionsHomeless patients, admitted to ICU matched to non-homeless patients by age and sex (characteristics most commonly used by clinicians), have higher hospital mortality despite similar comorbidities and illness severity. Trends to longer durations of life supports may have contributed to the higher mortality. Additional research is required to validate this higher mortality and develop strategies to improve outcomes in this vulnerable population.

Nature of nursing errors and their contributing factors in intensive care units

“…In the current study, about two‐thirds of patients involved in the reported errors exhibited low health literacy, communication difficulties or isolation. This finding reflects the general characteristics of patients in ICUs (Ostermann et al, ; Smith et al, ). Further, these patients, compared with other patients, are unstable, require more complicated nursing care and cannot protect themselves (Beccaria et al, ; Garrouste‐Orgeas et al, ; Wittich et al, ).…”

Defining Community-Acquired Pneumonia as a Public Health Threat: Arguments in Favor from Spanish Investigators

“…Pneumonia has a particularly strong impact on vulnerable populations. CAP is frequent among refugees [10], the homeless [11][12][13][14], drug users [15,16] and people of low socioeconomic status [17] and is associated with increased mortality.…”

Epidemiology, Characteristics, and Outcomes of ICU-Managed Homeless Patients: A Population-Based Study

“…Details of the type and number of organ failures have not been reported in other studies of homeless ICU admissions [ 8 , 9 ] or contemporary population-level studies of ICU admissions in the general US population, precluding direct comparisons of severity, as traditional severity of illness scores could not be derived from administrative data. However, recent reports of ICU admissions of the homeless described patients with much higher severity of illness than in our cohort, as judged by the higher use of mechanical ventilation (44% [ 8 ] and 56% [ 9 ]) and high mortality (20.8% [ 8 ] and 29% [ 9 ]). The difference likely represents a combination of both local practice patterns at study hospitals and lower availability of ICU beds outside the US [ 37 ].…”

“…However, data on critically ill homeless patients remain sparse. Two recent studies from France [ 8 ] and Canada [ 9 ] described high severity of illness, resource utilization, and hospital mortality of ICU-managed homeless patients. However, these studies were limited by small cohort size and examination of single-center data.…”