School of Medicine, University of Utah, Salt Lake City, Utah, USA.
Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah, USA.
Neurosurgery. 2023 Aug 1;93(2):292-299. doi: 10.1227/neu.0000000000002408. Epub 2023 Mar 9.
Homelessness is associated with high risk of acute neurotraumatic injury in the ∼600 000 Americans affected on any given night.
To compare care patterns and outcomes between homeless and nonhomeless individuals with acute neurotraumatic injuries.
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.
Of 1308 patients, 8.5% (n = 111) were homeless on admission to neurointensive care. Compared with nonhomeless 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]).
Homeless individuals experience longer hospital stays, more inpatient complications such as myocardial infarction, and more unplanned readmissions after discharge compared with their housed counterparts. These findings combined with limited discharge options in the homeless population indicate that better guidance is needed to improve the postoperative disposition and long-term care of this vulnerable patient population.
在美国，约有 60 万人在任何一个夜晚都会受到急性神经创伤损伤的高风险影响，无家可归与这种损伤密切相关。
比较无家可归和非无家可归的急性神经创伤损伤患者的护理模式和结局。
本回顾性横断面研究于 2015 年 1 月 1 日至 2020 年 12 月 31 日在我们的一级创伤中心进行，对因急性神经创伤损伤住院的成年人进行了评估。我们评估了人口统计学、住院期间特征、出院安置、再入院和调整后的再入院风险。
在 1308 名患者中，有 8.5%（n=111）在入住神经重症监护病房时无家可归。与非无家可归者相比，无家可归者更年轻（P=0.004）、主要为男性（P=0.003）、身体状况较好（P=0.003），但入院时格拉斯哥昏迷量表评分相似（P=0.85）、神经重症监护病房停留时间相似（P=0.15）、神经外科干预相似（P=0.27）、院内死亡率相似（P=0.17）。然而，无家可归者的住院时间更长（11.8 天比 10.0 天，P=0.02）、非计划再入院率更高（15.3%比 4.8%，P<0.001）、住院期间并发症更多（54.1%比 35.8%，P=0.01），特别是心肌梗死（9.0%比 1.3%，P<0.001）。无家可归者主要出院至以前的居住情况（46.8%）。再入院主要是因为急性和慢性颅内血肿（4.5%）。无家可归是 30 天非计划性再入院的独立预测因素（比值比 2.41[95%置信区间 1.33-4.38，P=0.004]）。
与有房者相比，无家可归者的住院时间更长，住院期间并发症更多，如心肌梗死，出院后非计划性再入院率更高。这些发现，加上无家可归人群中有限的出院选择，表明需要更好的指导，以改善这一脆弱患者群体的术后处置和长期护理。
