ABSTRACT

Primary Objective

Established literature demonstrates that homeless individuals experience both greater disease burden and risk of experiencing traumatic brain injury (TBI) than the general population. Similarly, shared risk factors for both homelessness and/or TBI may exacerbate the risk of repetitive neurotrauma within homeless populations.

Research Design

We leveraged a state-wide trauma registry, the Pennsylvania Trauma Outcome Study (PTOS), to characterize 609 patients discharged to homeless (58% TBI, 42% orthopedic injury (OI)) in comparison to 609 randomly sampled adult patients discharged to home.

Methods and Procedures

We implemented Chi-square tests to examine preexisting health conditions (PECs), hospital course, and injury mechanisms for both patient groups.

Main Outcomes and Results

Homelessness affects a greater proportion of nonwhite patients, and homeless patients present for care with increased frequencies of psychiatric and substance use PECs, and alcohol-positive TBI. Furthermore, assault impacts a larger proportion of homeless patients, and the window for overnight assault risk resulting in TBI is extended for these patients compared to patients discharged to home.

Conclusion

Given the shifting conceptualization of TBI as a chronic condition, identifying homeless patients on admission to trauma centers, rather than retrospectively at discharge, can enhance understanding of the challenges facing the homeless as they age with both a complex neurotrauma history and multimorbidity.

摘要

主要目标

既定文献表明，与一般人群相比，无家可归者经历了更大的疾病负担和遭受创伤性脑损伤 (TBI) 的风险。同样，无家可归和/或 TBI 的共同风险因素可能会加剧无家可归人群中重复性神经创伤的风险。

研究设计

我们利用全州范围的创伤登记，宾夕法尼亚创伤结果研究 (PTOS)，将 609 名出院无家可归的患者（58% TBI，42% 骨科损伤 (OI)）与 609 名随机抽样的出院成年患者进行比较。

方法和程序

我们实施了卡方检验来检查两个患者组的既往健康状况 (PEC)、医院病程和损伤机制。

主要成果和成果

无家可归影响了更大比例的非白人患者，而无家可归的患者就诊时精神病和物质使用 PEC 以及酒精阳性 TBI 的频率增加。此外，袭击影响了更大比例的无家可归患者，与出院回家的患者相比，这些患者发生夜间袭击导致 TBI 的风险窗口扩大了。

结论

鉴于 TBI 作为一种慢性疾病的概念转变，在进入创伤中心时识别无家可归的患者，而不是在出院时进行回顾，可以增强对无家可归者面临的挑战的理解，因为他们随着年龄的增长而具有复杂的神经创伤史和多种疾病。