Trauma in adults experiencing homelessness

Miller, Jean Philippe; Reilly, Gerard M. O’; Mackelprang, Jessica L.; Mitra, Biswadev

doi:10.1016/j.injury.2020.02.086

Cited by 16 publications

(18 citation statements)

References 58 publications

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“…[30][31][32][33] Prior studies have demonstrated that burns and exposure-related injury were common among PEH. [34][35][36] However, these studies were single center or city focused. Exposure to different mechanisms of…”

Section: Discussionmentioning

confidence: 99%

Injury Patterns and Hospital Admission After Trauma Among People Experiencing Homelessness

et al. 2023

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ImportanceTraumatic injury is a major cause of morbidity for people experiencing homelessness (PEH). However, injury patterns and subsequent hospitalization among PEH have not been studied on a national scale.ObjectiveTo evaluate whether differences in mechanisms of injury exist between PEH and housed trauma patients in North America and whether the lack of housing is associated with increased adjusted odds of hospital admission.Design, Setting, and ParticipantsThis was a retrospective observational cohort study of participants in the 2017 to 2018 American College of Surgeons’ Trauma Quality Improvement Program. Hospitals across the US and Canada were queried. Participants were patients aged 18 years or older presenting to an emergency department after injury. Data were analyzed from December 2021 to November 2022.ExposuresPEH were identified using the Trauma Quality Improvement Program’s alternate home residence variable.Main Outcomes and MeasuresThe primary outcome was hospital admission. Subgroup analysis was used to compared PEH with low-income housed patients (defined by Medicaid enrollment).ResultsA total of 1 738 992 patients (mean [SD] age, 53.6 [21.2] years; 712 120 [41.0%] female; 97 910 [5.9%] Hispanic, 227 638 [13.7%] non-Hispanic Black, and 1 157 950 [69.6%] non-Hispanic White) presented to 790 hospitals with trauma, including 12 266 PEH (0.7%) and 1 726 726 housed patients (99.3%). Compared with housed patients, PEH were younger (mean [SD] age, 45.2 [13.6] years vs 53.7 [21.3] years), more often male (10 343 patients [84.3%] vs 1 016 310 patients [58.9%]), and had higher rates of behavioral comorbidity (2884 patients [23.5%] vs 191 425 patients [11.1%]). PEH sustained different injury patterns, including higher proportions of injuries due to assault (4417 patients [36.0%] vs 165 666 patients [9.6%]), pedestrian-strike (1891 patients [15.4%] vs 55 533 patients [3.2%]), and head injury (8041 patients [65.6%] vs 851 823 patients [49.3%]), compared with housed patients. On multivariable analysis, PEH experienced increased adjusted odds of hospitalization (adjusted odds ratio [aOR], 1.33; 95% CI, 1.24-1.43) compared with housed patients. The association of lacking housing with hospital admission persisted on subgroup comparison of PEH with low-income housed patients (aOR, 1.10; 95% CI, 1.03-1.19).Conclusions and RelevanceInjured PEH had significantly greater adjusted odds of hospital admission. These findings suggest that tailored programs for PEH are needed to prevent their injury patterns and facilitate safe discharge after injury.

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Section: Discussionmentioning

confidence: 99%

Injury Patterns and Hospital Admission After Trauma Among People Experiencing Homelessness

et al. 2023

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“…These patient demographics are consistent with other studies on homeless patients. 11,12 Our multivariate analysis was able to control and eliminate the effect of these aspects on our studied outcomes. However, in clinical practice, it is important to recognize the increased risk to tissue healing, as well as mechanical and medical complications associated with these life habits.…”

Section: Discussionmentioning

confidence: 99%

Total Joint Arthroplasty in Homeless Patients at an Urban Safety Net Hospital

Niu

Egan

Fang

et al. 2022

J Am Acad Orthop Surg

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Introduction: Homelessness is a key social determinant of health, and the patient population has grown to over 580,000. Total joint arthroplasty (TJA) is an effective treatment of symptomatic end-stage osteoarthritis of the hip and knee and has been shown to improve health-related quality of life in the general population. However, the literature on the outcomes of TJA among homeless patients is limited. Methods: We retrospectively reviewed 442 patients who underwent primary, unilateral TJA between June 1, 2016, and August 31, 2017, at an urban, tertiary, academic safety net hospital. Based on self-reported living status, we classified 28 homeless patients and 414 control nonhomeless patients. Fisher exact tests, Student t-tests, and multivariate logistic regression were used to compare the demographics, preoperative conditions, and surgical outcomes between the two groups. Results: The homeless group were younger, more often male, and smokers; had alcohol use disorder; and used illicit drugs. After controlling for age, sex, and preoperative medical and social conditions, homeless patients were 15.83 times more likely to have an emergency department visit (adjusted odds ratio, 15.83; 95% confidence interval, 5.05 to 49.59; P , 0.0001) within 90 days but had similar rates of readmission (P = 0.25), revision surgery (P = 0.38), and prosthetic joint infection (P = 0.25) when compared with nonhomeless patients. Discussion: Although homeless patients did not have higher rates of readmission or revision surgery, homelessness still presents unique challenges for the TJA patients and providers. With careful preoperative optimization and collaborative support, however, the benefits of TJA may outweigh the risk of poor outcomes for these patients.

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“…This population also has a higher rate of psychiatric-related admissions. 29 Intoxicated trauma patients are less likely to sustain severe injuries. 30,31 However, they are more likely to present with a depressed Glasgow Coma Scale score, 32 which is usually associated with intracranial trauma, hypoxia, or shock from associated injuries.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, patients who are undomiciled are more than twice as likely to present with positive BAC after a trauma than a comparative sample of domiciled patients. 29 This may complicate the discharge process for lower ISS patients who do not have reliable transportation, a shelter to return to, or a follow-up plan. This population also has a higher rate of psychiatric-related admissions.…”

Section: Discussionmentioning

confidence: 99%

Association of Blood Alcohol and Alcohol Use Disorders with Emergency Department Disposition of Trauma Patients

Hoonpongsimanont

Ghanem

Sahota

et al. 2022

WestJEM

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Introduction: Trauma patients who present to the emergency department (ED) intoxicated or with an alcohol use disorder (AUD) undergo more procedures and have an increased risk of developing complications. However, how AUD and blood alcohol concentration (BAC) impact a trauma patient’s disposition from the ED remains inconclusive. In this study we aimed to identify the associations between positive BAC or an AUD with admission to the hospital, including the intensive care unit (ICU). Methods: This was a retrospective study analyzing data from 2010–2018 at a university-based, Level I trauma ED. Included in the study were 4,699 adult trauma patients who completed the Alcohol Use Disorders Identification Test (AUDIT) and had blood alcohol content test results. Results: Positive BAC was associated with hospital admission and ICU admission after adjusting for injury severity score (ISS) (odds ratio 1.5 and 1.3, respectively). The AUDIT was only correlated with hospital and ICU admission in patients with ISS of 1 to 15. By increasing risk of AUD (low, moderate, high, and likely alcohol dependent) the proportion of ICU admissions rose from 29.3% to 37.3%, 40.0% and 42.0% (P <0.01). The results did not change significantly by adjustment for the age of patients. Conclusion: BAC is associated with increasing ED disposition to the hospital or ICU. Furthermore, self-reported alcohol use was associated with an increased risk of hospital or ICU admission in patients with minor or moderate injuries. Further studies to determine viable options to decrease admission rates in these patients are warranted.

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Trauma in adults experiencing homelessness

Cited by 16 publications

References 58 publications

Injury Patterns and Hospital Admission After Trauma Among People Experiencing Homelessness

Injury Patterns and Hospital Admission After Trauma Among People Experiencing Homelessness

Total Joint Arthroplasty in Homeless Patients at an Urban Safety Net Hospital

Association of Blood Alcohol and Alcohol Use Disorders with Emergency Department Disposition of Trauma Patients

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