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Understanding the Unique Challenges Faced by Homeless Patients With Acute Traumatic Neurosurgical Injuries

机译：Understanding the Unique Challenges Faced by Homeless Patients With Acute Traumatic Neurosurgical Injuries

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摘要

BACKGROUND: Homelessness is associated with high risk of acute neurotraumatic injury in the ~600000 Americans affected on any given night. OBJECTIVE: To compare care patterns and outcomes between homeless and nonhomeless individuals with acute neurotraumatic injuries. METHODS: Adults hospitalized for acute neurotraumatic injuries between January 1, 2015, and December 31, 2020, were identified in this retrospective cross-sectional study at our Level 1 trauma center. We evaluated demographics, in-hospital characteristics, discharge dispositions, readmissions, and adjusted readmission risk. RESULTS: Of 1308 patients, 8.5 (n = 111) were homeless on admission to neurointensive care. Compared with non-homeless individuals, homeless patients were younger (P = .004), predominantly male (P = .003), and less frail (P = .003) but had similar presenting Glasgow Coma Scale scores (P = .85), neurointensive care unit stay time (P = .15), neurosurgical interventions (P = .27), and in-hospital mortality (P = .17). Nevertheless, homeless patients had longer hospital stays (11.8 vs 10.0 days, P = .02), more unplanned readmissions (15.3 vs 4.8, P < .001), and more complications while hospitalized (54.1 vs 35.8, P = .01), particularly myocardial infarctions (9.0 vs 1.3, P < .001). Homeless patients were mainly discharged to their previous living situation (46.8). Readmissions were primarily for acute-on-chronic intracranial hematomas (4.5). Homelessness was an independent predictor of 30-day unplanned readmissions (odds ratio 2.41 95 CI 1.33-4.38, P = .004).

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