Kiwanuka Harriet, Maan Zeshaan N, Rochlin Danielle, Curtin Catherine, Karanas Yvonne, Sheckter Clifford C
Division of Plastic & Reconstructive Surgery, Stanford University, Stanford, California.
Division of Plastic Surgery, Veterans Affairs Palo Alto, Palo Alto, California.
J Burn Care Res. 2019 Aug 14;40(5):633-638. doi: 10.1093/jbcr/irz045.
Burn injuries are common in the homeless population. Little is known regarding whether homeless patients experience different outcomes when admitted for burns. We aim to 1) characterize the admitted homeless burn population, and 2) investigate differences in inpatient outcomes between the homeless and non-homeless populations. A retrospective cohort study was performed utilizing the Nationwide Inpatient Sample. Adult patients with complete data for burn characteristics were extracted. Variables included demographic, burn, and facility characteristics. Homelessness was identified with International Classification of Disease 9th edition codes. Outcomes were modeled with regression analysis and included length of stay, total operations, charges, disposition, and Patient Safety Indicators (PSIs). 43,872 encounters were included of which 0.76% were homeless. Homeless encounters were more likely to be male (P < .001) and Medicaid-insured (P < .001). Flame and frostbite injuries were more likely (P < .001), and the mean %TBSA was smaller (15.0 vs 16.8, P < .001). After adjustment, homeless patients had greater lengths of stay (11.5 vs 9.6, P = .046), greater charges ($73,597 vs $66,909, P = .030), fewer operations (P = .016), and three times higher likelihood leaving against medical advice (P = .002). There was no difference in PSIs or mortality. Homeless burn admissions represent a unique cohort that carries a higher comorbidity burden and experiences longer lengths of stay with greater difficulty in disposition. Ironically, these patients accumulate more charges with limited means to pay. Even though no differences were observed in PSIs or mortality, further research is needed to understand how the challenges within this population affect their recovery.
烧伤在无家可归者群体中很常见。关于无家可归的患者因烧伤入院时是否会有不同的治疗结果，目前所知甚少。我们的目标是：1）描述入院的无家可归烧伤患者群体；2）调查无家可归者和非无家可归者群体在住院治疗结果上的差异。利用全国住院患者样本进行了一项回顾性队列研究。提取了具有完整烧伤特征数据的成年患者。变量包括人口统计学、烧伤和医疗机构特征。通过国际疾病分类第九版编码来确定无家可归状态。通过回归分析对治疗结果进行建模，包括住院时间、总手术次数、费用、出院情况和患者安全指标（PSI）。共纳入43872例病例，其中0.76%为无家可归者。无家可归者更可能为男性（P < 0.001）且参保医疗补助（P < 0.001）。火焰伤和冻伤更常见（P < 0.001），平均烧伤总面积较小（15.0对16.8，P < 0.001）。调整后，无家可归患者的住院时间更长（11.5对9.6，P = 0.046），费用更高（73597美元对66909美元，P = 0.030），手术次数更少（P = 0.016），违背医嘱出院的可能性高出三倍（P = 0.002）。在患者安全指标或死亡率方面没有差异。无家可归者烧伤入院代表了一个独特的队列，其合并症负担更高，住院时间更长，出院困难更大。具有讽刺意味的是，这些患者费用更高，但支付能力有限。尽管在患者安全指标或死亡率方面未观察到差异，但仍需要进一步研究以了解该群体面临的挑战如何影响他们的康复。
