Kramer C Bradley, Gibran Nicole S, Heimbach David M, Rivara Frederick P, Klein Matthew B
Department of Surgery's Burn Center, University of Washington, Seattle, USA.
J Burn Care Res. 2008 May-Jun;29(3):461-7. doi: 10.1097/BCR.0b013e31817112b0.
The homeless are at an increased risk for traumatic injury, but little is known about the injury etiology and outcome of homeless persons who sustain burn injuries. In this study, we analyze patient and injury characteristics of homeless persons admitted to a regional burn center. This is a retrospective cohort study of patients admitted to our burn center between 1994 and 2005. A total of 3700 adult patients were admitted during the study period and, of these, 72 (1.9%) were homeless. The cohort of homeless patients was compared with domiciled adult patients admitted during the same time period, analyzing baseline patient and injury characteristics and injury outcomes. Overall, homeless patients had more extensive burn injuries than domiciled patients (17.8% vs 11.2%TBSA, P < .001) and overall longer lengths of hospital stay (22 vs 12 days, P < .001). The homeless population also had significantly higher rates of alcohol (80.6% vs 12.8%, P < .001) and drug abuse (59.4% vs 12.8%, P < .001), history of mental illness (45.2% vs 11.0%, P < .001), and injury by assault (13.9% vs 2.0%, P < .001). Homeless patients tended to have more severe injuries; higher rates of substance abuse and mental illness; increased incidence of assault by burning; and longer lengths of hospital stay. Hospitalization of a homeless patient following injury may provide a unique opportunity to address co-occurring substance abuse and mental illness and approach injury prevention to improve patients' outcomes and reduce injury recidivism.
无家可归者遭受创伤性损伤的风险增加，但对于遭受烧伤的无家可归者的损伤病因和预后知之甚少。在本研究中，我们分析了入住某地区烧伤中心的无家可归者的患者和损伤特征。这是一项对1994年至2005年间入住我们烧伤中心的患者进行的回顾性队列研究。在研究期间，共有3700名成年患者入院，其中72名（1.9%）为无家可归者。将无家可归患者队列与同期入住的有住所成年患者进行比较，分析患者基线特征、损伤特征和损伤结局。总体而言，无家可归患者的烧伤面积比有住所患者更大（17.8% vs 11.2% 体表面积，P < .001），住院总时长也更长（22天 vs 12天，P < .001）。无家可归人群的酒精滥用率（80.6% vs 12.8%，P < .001）、药物滥用率（59.4% vs 12.8%，P < .001）、精神疾病史（45.2% vs 11.0%，P < .001）以及袭击致伤率（13.9% vs 2.0%，P < .001）也显著更高。无家可归患者往往损伤更严重；药物滥用和精神疾病发生率更高；烧伤袭击的发生率增加；住院时间更长。无家可归患者受伤后的住院治疗可能为解决同时存在的药物滥用和精神疾病问题以及采取预防损伤措施提供独特机会，以改善患者预后并减少损伤复发。
