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The homeless orthopaedic trauma patient: follow-up, emergency room usage, and complications
Harrison F Kay1, Vasanth Sathiyakumar, Kristin R Archer
1Vanderbilt Department of Orthopaedic Surgery, Vanderbilt Orthopaedic Institute, Center for Health Policy, Vanderbilt University, Nashville, TN.
Objectives:
To review homeless patients with orthopaedic trauma injuries and examine their emergency room (ER) usage, follow-up rates, and complication rates.
Design:
Retrospective chart review.
Setting:
Patients presenting to a level 1 trauma center with orthopaedic trauma injuries from 2001 to 2010.
Patients/Participants:
Sixty-three uninsured homeless patients and 63 uninsured nonhomeless patients with orthopaedic trauma injuries were included.
Intervention:
Homeless patients with orthopaedic trauma were identified through ER intake sheets and current procedural terminology code searches.
Main Outcome Measurements:
ER usage, orthopaedic clinic follow-up, and complications.
Results:
After the index visit to the ER for their orthopaedic trauma injuries, homeless patients demonstrated more ER visits and had fewer orthopaedic clinic follow-up visits than nonhomeless patients (P < 0.001). There were no significant differences among the type of complications (none, infection, hardware failure, and nonunion) between the homeless and the nonhomeless patients (P = 0.23). Operative homeless patients returned to the orthopaedic clinic for follow-up more than nonoperative homeless patients (mean = 5.4, SD = 7.6; and mean = 1.2, SD = 1.5, respectively; P < 0.001).
Conclusions:
Our data are the first to examine the problems associated with homelessness in the patient with orthopaedic trauma and demonstrate an increased challenge in the follow-up care. The orthopaedic surgeon must consider these issues in managing this complex patient population.
Level Of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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