Trauma and Acute Care Surgery, Penn Medicine Lancaster General Health, Lancaster, PA, USA.
Am Surg. 2023 Jun;89(6):2362-2367. doi: 10.1177/00031348221083952. Epub 2022 Apr 21.
On any given day, there are >550,000 homeless persons in the United States. Little research has examined the relationship between the homeless population and traumatic injuries. We hypothesized that homeless trauma patients have a higher mortality compared to those who are not homeless.
The Pennsylvania Trauma Outcome Study database was retrospectively queried from 2003-2018 for all adult (age ≥15) patients admitted to trauma centers in Pennsylvania. Homelessness was defined as homeless on admission or homeless as their discharge status. Patient demographics, comorbidities, and clinical variables were compared between homeless and non-homeless patients. Logistic regression was used to control for age, gender, injury severity, injury type, admission Glasgow Coma Scale, and systolic blood pressure to assess morbidity and mortality.
773 patients were identified upon query. Homeless trauma patients were more likely to be male, younger, black, and of Hispanic ethnicity. Compared to non-homeless, they were more likely to have a positive drug screen or mental illness at the time of injury. They were not more significantly injured than their counterparts; however, in adjusted analysis, the homeless had significantly higher odds of both complications (Adjusted Odds Ratio [AOR]: 3.11; 95%CI: 2.64-3.66, < .001) and mortality (AOR: 1.79; 95%CI: 1.29-2.50, = .001).
Although homeless patients were not more severely injured than the general trauma population, they had significantly higher odds of both complications and mortality. This population represents a very vulnerable community in need of medical intervention and injury prevention programs.
在美国，每天有超过 55 万无家可归者。很少有研究探讨无家可归人群与创伤性损伤之间的关系。我们假设无家可归的创伤患者的死亡率高于非无家可归者。
从 2003 年至 2018 年，我们对宾夕法尼亚创伤结局研究数据库进行了回顾性查询，以获取所有在宾夕法尼亚创伤中心接受治疗的成年（年龄≥15 岁）患者。无家可归是指入院时无家可归或出院时无家可归。比较无家可归和非无家可归患者的人口统计学、合并症和临床变量。使用逻辑回归来控制年龄、性别、创伤严重程度、损伤类型、入院格拉斯哥昏迷量表和收缩压，以评估发病率和死亡率。
查询后确定了 773 名患者。无家可归的创伤患者更可能是男性、年轻、黑人且具有西班牙裔血统。与非无家可归者相比，他们在受伤时更有可能有药物检测阳性或患有精神疾病。他们的受伤程度并不比对照组更严重；然而，在调整分析中，无家可归者在并发症（调整后的优势比 [AOR]：3.11；95%CI：2.64-3.66， <.001）和死亡率（AOR：1.79；95%CI：1.29-2.50， =.001）方面的几率明显更高。
尽管无家可归的患者受伤程度不比一般创伤人群严重，但他们在并发症和死亡率方面的几率明显更高。这一人群代表了一个非常脆弱的社区，需要医疗干预和伤害预防计划。
