Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA; Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
Division of Plastic & Reconstructive Surgery, Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA.
Burns. 2024 Jun;50(5):1091-1100. doi: 10.1016/j.burns.2024.02.030. Epub 2024 Mar 1.
Burn injuries among the homeless are increasing as record numbers of people are unsheltered and resort to unsafe heating practices. This study characterizes burns in homeless encounters presenting to US emergency departments (EDs).
Burn encounters in the 2019 Nationwide Emergency Department Sample (NEDS) were queried. ICD-10 and CPT codes identified homelessness, injury regions, depths, total body surface area (TBSA %), and treatment plans. Demographics, comorbidities, and charges were analyzed. Discharge weights generated national estimates. Statistical analysis included univariate testing and multivariate modeling.
Of 316,344 weighted ED visits meeting criteria, 1919 (0.6%) were homeless. Homeless encounters were older (mean age 44.83 vs. 32.39 years), male-predominant (71% vs. 52%), and had more comorbidities, and were more often White or Black race (p < 0.001). They more commonly presented to EDs in the West and were covered by Medicaid (51% vs. 33%) (p < 0.001). 12% and 5% of homeless burn injuries were related to self-harm and assault, respectively (p < 0.001). Homeless encounters experienced more third-degree burns (13% vs. 4%; p < 0.001), though TBSA % deciles were not significantly different (34% vs. 33% had TBSA % of ten or lower; p = 0.516). Homeless encounters were more often admitted (49% vs. 7%; p < 0.001), and homelessness increased odds of admission (OR 4.779; p < 0.001). Odds of transfer were significantly lower (OR 0.405; p = 0.021).
Homeless burn ED encounters were more likely due to assault and self-inflicted injuries, and more severe. ED practitioners should be aware of these patients' unique presentation and triage to burn centers accordingly.
由于无家可归者的人数创历史新高，他们诉诸不安全的取暖方式，因此烧伤人数不断增加。本研究描述了在美国急诊部（ED）就诊的无家可归者烧伤情况。
查询了 2019 年全国急诊部样本（NEDS）中的烧伤病例。使用 ICD-10 和 CPT 代码确定无家可归、受伤区域、深度、总体表面积（TBSA%）和治疗计划。分析了人口统计学、合并症和费用。出院权重生成了全国估计数。统计分析包括单变量检验和多变量建模。
在符合标准的 316344 例加权 ED 就诊中，有 1919 例（0.6%）是无家可归者。无家可归者的年龄较大（平均年龄 44.83 岁 vs. 32.39 岁），男性居多（71% vs. 52%），合并症更多，且更常为白种人或黑种人（p<0.001）。他们更常到西部的急诊就诊，且更多地由医疗补助计划（Medicaid）覆盖（51% vs. 33%）（p<0.001）。分别有 12%和 5%的无家可归者烧伤与自残和袭击有关（p<0.001）。无家可归者的三度烧伤更多（13% vs. 4%；p<0.001），但 TBSA%的十分位数没有显著差异（34% vs. 33%的 TBSA%为十分之一或更低；p=0.516）。无家可归者更常被收治入院（49% vs. 7%；p<0.001），且无家可归状态增加了收治入院的可能性（OR 4.779；p<0.001）。转院的可能性显著降低（OR 0.405；p=0.021）。
无家可归者的 ED 烧伤就诊更可能是由于袭击和自残造成的，且烧伤更严重。急诊医生应该意识到这些患者的独特表现，并相应地将他们分诊至烧伤中心。
