Abstract
BackgroundTrauma systems are designed to provide specialized treatment for the most severely injured. As populations change, it is imperative for trauma centers to remain dynamic to provide the best care to all members of the community.MethodsA retrospective review of all trauma patients treated at one Level II trauma center in Southern CA over 5 years. Three cohorts of patients were studied: geriatric (> 65 years), the homeless, and all other trauma patients. Triage, hospitalization, and outcomes were collected and analyzed.ResultsOf 8431 patients treated, 30% were geriatric, 3% homeless and 67% comprised all other patients. Trauma activation criteria was met for 84% of all other trauma patients, yet only 61% of homeless and geriatric patients combined. Injury mechanism for homeless included falls (38%), pedestrian/bicycle related (27%) and assaults (24%), often while under the influence of alcohol and drugs. Average length of hospital stay (LOS) was greater for homeless and geriatric patients and frequently attributed to discharge planning challenges. Both the homeless and geriatric groups demonstrated increased complications, comorbidities, and death rates.ConclusionsHomeless trauma patients reflect similar challenges in care as with the elderly, requiring additional resources and more complex case management. It is prudent to identify and understand the issues surrounding patients transported to our trauma center requiring a higher level of care yet are under-triaged upon arrival to the Emergency Department. Although a monthly review is done for all under-triaged patients, and geriatric patients are acknowledged to be a cohort continually having delays, the homeless cohort continues to be under-triaged. The admitted homeless trauma patient has similar complex case management issues as the elderly related to pre-existing health issues and challenges with discharge planning, both which can add to longer lengths of hospital stay as compared to other trauma patients. Given the lack of social support that is endemic to both populations, these cohorts represent a unique challenge to trauma centers. Further research into specialized care is required to determine best practices to address disparities evident in the homeless and elderly, and to promote health equity in marginalized populations.
Highlights
Trauma systems are designed to provide specialized treatment for the most severely injured
Eight thousand four hundred thirty-one trauma patients were treated over the five-year period, and comprised of 3% (248) homeless, 30% (2545) geriatric and 67% (5638) all other trauma patients
Males were the predominant gender in all three groups, with the largest proportion within the homeless cohort (88% male)
Summary
Trauma systems are designed to provide specialized treatment for the most severely injured. The United States Department of Housing and Urban Development annual homeless survey estimated that 553 thousand people were homeless across the nation on a given night in January 2018. One study found that 80.6% of homeless admissions in New York public hospitals had a primary or secondary diagnosis of substance abuse or mental illness (Salit et al 1998). These potentially preventable or treatable comorbidities can create a higher risk for injury and often lead to higher rates of admission, longer than average hospitalization, and are associated with significantly higher costs (Salit et al 1998; Kushel et al 2002)
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