Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia.
Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia.
Injury. 2020 Apr;51(4):897-905. doi: 10.1016/j.injury.2020.02.086. Epub 2020 Feb 20.
Homeless individuals suffer a greater burden of health problems than the general population. This study aimed to describe the epidemiology of physical trauma among homeless patients presenting to an urban major trauma center and to ascertain any differences in the nature, injury severity and outcomes among homeless compared to domiciled patients.
A retrospective matched cohort study that included adults who met inclusion criteria for The Alfred Hospital Trauma Registry between 01 July 2010 and 31 March 2017 was conducted. Primary homelessness was identified using the International Statistical Classification of Diseases, 10th Revision Coding Z59.0 and/or 'No fixed abode' address data. Homeless and domiciled patients were matched at a 1:2 ratio on age, sex, month and year of injury. The primary outcome variable was the Injury Severity Score (ISS). Secondary outcomes were hospital length of stay (LOS), mortality, emergency department (ED) disposition, hospital disposition, discharge processes and trauma registry recidivism.
Of 25,920 cases in the trauma registry, 147 (0.6%) were identified as homeless, comprising 131 unique homeless individuals who were matched with 262 domiciled patients. The median (Inter-Quartile Range) ISS among homeless patients was 5(2-10), compared to 9(4-17) for domiciled patients (p < 0.001). Homeless patients had significantly lower odds of sustaining an injury with ISS>12 (OR 0.5, 95% CI: 0.3-0.8, p = 0.001). Homeless patients were treated more often than domiciled patients for assault (32.1% vs 9.5%), intentional self-harm (10.7% vs 2.7%), and penetrating injury (16.0% vs 6.5%). Homeless patients had higher rates of psychiatry admissions (9.2% vs 0.8%), positive blood alcohol concentration (30.5% vs 13.7%), and higher odds of discharging against medical advice (DAMA)(OR 2.0, 95% CI: 1.1-3.6 p = 0.02). There were no differences in LOS (p = 0.51), mortality (p = 0.19), ED disposition (p = 0.64) or trauma registry recidivism (p = 0.09).
Among injured patients who presented at an urban trauma center, homelessness was associated with higher odds of assault, intentional self-harm, penetrating injury, psychiatry admissions, DAMA but lower ISS than domiciled patients. Variable definitions of homelessness and lack of standardized documentation in the medical record should be addressed to ensure these vulnerable patients are identified and linked with peripheral services.
无家可归者比普通人群承受更大的健康问题负担。本研究旨在描述在城市主要创伤中心就诊的无家可归患者的身体创伤流行病学，并确定与有住所的患者相比，无家可归者在性质、损伤严重程度和结局方面是否存在差异。
对 2010 年 7 月 1 日至 2017 年 3 月 31 日期间符合 The Alfred 医院创伤登记处纳入标准的成年人进行了回顾性匹配队列研究。主要无家可归者是通过国际疾病分类第 10 次修订版 Z59.0 编码和/或“无固定住所”地址数据确定的。无家可归者和有住所者按年龄、性别、受伤月份和年份以 1:2 的比例进行匹配。主要结局变量为损伤严重度评分（ISS）。次要结局是住院时间（LOS）、死亡率、急诊科（ED）处置、医院处置、出院流程和创伤登记处再入院。
在创伤登记处的 25920 例病例中，有 147 例（0.6%）被确定为无家可归者，其中 131 例为无家可归者，他们与 262 例有住所的患者相匹配。无家可归者的中位数（四分位距）ISS 为 5（2-10），而有住所者为 9（4-17）（p<0.001）。与有住所者相比，无家可归者发生 ISS>12 的损伤的可能性显著降低（OR 0.5，95%CI：0.3-0.8，p=0.001）。无家可归者比有住所者更常因攻击（32.1%比 9.5%）、故意自残（10.7%比 2.7%）和穿透性损伤（16.0%比 6.5%）而接受治疗。无家可归者精神病入院率更高（9.2%比 0.8%）、血液酒精浓度阳性率更高（30.5%比 13.7%），以及更有可能未经医嘱出院（DAMA）（OR 2.0，95%CI：1.1-3.6，p=0.02）。两组 LOS（p=0.51）、死亡率（p=0.19）、ED 处置（p=0.64）或创伤登记处再入院（p=0.09）均无差异。
在城市创伤中心就诊的受伤患者中，无家可归与攻击、故意自残、穿透性损伤、精神病入院、DAMA 的可能性更高有关，但 ISS 低于有住所者。无家可归的定义变量和病历中缺乏标准化记录应予以解决，以确保这些弱势群体得到识别并与周边服务联系起来。
