Outcomes and characteristics differ between homeless and housed trauma patients following the COVID-19 pandemic

Background: Americans experiencing homelessness are uniquely vulnerable to traumatic injuries and morbidity. Despite a high and increasing number of persons experiencing homelessness (PEH), American researchers have not comprehensively described the impact of this social problem on trauma patients in recent years.

Study design: Retrospective cohort study using the American College of Surgeons TQIP 2021-2022 data. We performed descriptive statistics and multivariable modeling to test for differences in clinical characteristics and discharge dispositions between adult trauma patients experiencing homelessness (n = 20,692) and housed trauma patients (n = 1,927,159).

Results: Trauma patients experiencing homelessness are more likely to be male, younger, and belong to different racial / ethnic groups. Homeless trauma patients have 37 % longer hospital stays than housed trauma patients and are more likely to experience an assault (adjusted OR: 2.92) or self-inflicted injury (adjusted OR: 1.50) and less likely to experience an unintentional injury (adjusted OR: 0.33). Homeless trauma patients' mechanisms of injury differ from those of housed trauma patients. They are similarly likely to have an ISS score of 12 or higher (adjusted OR: 1.01). They are slightly less likely to experience in-hospital mortality than housed trauma patients (adjusted OR: 0.85). They are more likely to be discharged to court or law enforcement (adjusted OR: 1.89); to a psychiatric facility or unit (adjusted OR: 2.99); leave against medical advice (adjusted OR: 3.89); or to a skilled nursing facility (adjusted OR: 2.01) than housed trauma patients. They are less likely to be discharged to inpatient rehab or home health than housed trauma patients.

Conclusions: This study describes differences in injury outcomes and clinical characteristics affecting homeless trauma patients compared to housed trauma patients since the COVID-19 pandemic, such as longer lengths of hospital stay, greater propensity to have violent injuries, and different discharge dispositions.