Homeless Patients in the ICU

Bigé, Naïke; Hejblum, Gilles; Baudel, Jean-Luc; Carron, Annie; Chevalier, Sophie; Pichereau, Claire; Maury, Éric; Guidet, Bertrand

doi:10.1097/ccm.0000000000000944

Cited by 21 publications

(27 citation statements)

References 47 publications

(58 reference statements)

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“…A recently published propensity-matched cohort study conducted in France described the epidemiology and outcomes of critically ill homeless patients [12]. This study compared 421 homeless to 9,353 non-homeless patients admitted over a 12-year period.…”

Section: Discussionmentioning

confidence: 99%

“…A recent systematic review noted the paucity of research related to the course and outcomes of homeless patients in the ICU [11]. In a subsequently published propensity-matched cohort from France, homelessness was not associated with ICU or hospital mortality but was associated with significantly longer ICU and hospital stays [12]. Given this higher use of hospital and intensive care resources and that intensive care is a limited and costly resource, a better understanding of the needs and outcomes of homeless critically ill patients would be useful for health system planning and improvement.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2017

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“…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.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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Despite advances in its prevention, pneumonia remains associated with high morbidity, mortality, and health costs worldwide. Studies carried out in the last decade have indicated that more patients with community-acquired pneumonia (CAP) now require hospitalization. In addition, pneumonia management poses many challenges, especially due to the increase in the number of elderly patients with multiple comorbidities, antibiotic-resistant pathogens, and the difficulty of rapid diagnosis. In this new call to action, we present a wide-ranging review of the information currently available on CAP and offer some reflections on ways to raise awareness of this disease among the general public. We discuss the burden of CAP and the importance of attaining better, faster microbiological diagnosis and initiating appropriate treatment. We also suggest that closer cooperation between health professionals and the population at large could improve the management of this largely preventable infectious disease that takes many lives each year.

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“…The later hypothesized risk may be magnified under conditions of homelessness. Finally, the well-documented high rates of hospital [ 29 ] and ICU [ 8 ] readmissions among the homeless, being markedly higher than that in the nonhomeless population, have contributed to the high ICU utilization among the former.…”

Section: Discussionmentioning

confidence: 99%

“…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.…”

Section: Introductionmentioning

confidence: 99%

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

Oud

2018

BioMed Research International

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Background The population-level demand for critical care services among the homeless (H) remains unknown, with only sparse data on the characteristics and outcomes of those managed in the ICU. Methods The Texas Inpatient Public Use Data File and annual federal reports were used to identify H hospitalizations and annual estimates of the H population between 2007 and 2014. The incidence of ICU admissions in the H population, the characteristics of ICU-managed H, and factors associated with their short-term mortality were examined. Results Among 52,206 H hospitalizations 15,553 (29.8%) were admitted to ICU. The incidence of ICU admission among state H population rose between 2007 and 2014 from 28.0 to 96.6/1,000 (p < 0.0001), respectively. Adults aged ≥ 45 years and minorities accounted for 70.2% and 57.6%, respectively, of the growth in volume of ICU admissions. Short-term mortality was 3.2%, with odds of death increased with age, comorbidity burden, and number of failing organs. Conclusions The demand for critical care services was increasingly high among the H and was contrasted by low short-term mortality among ICU admissions. These findings, coupled with the persistent health disparities among minority H, underscore the need to effectively address homelessness and reduce barriers to longitudinal appropriate prehospital care among the H.

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Homeless Patients in the ICU

Cited by 21 publications

References 47 publications

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

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

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

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

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