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Managing flail chest, a condition characterized by a segment of the chest wall moving independently from the rest of the thoracic cage, requires a comprehensive approach. It includes a thorough assessment of the patient's condition, a diagnostic evaluation to determine the extent of the injury, and the implementation of appropriate medical interventions tailored to the individual's needs.
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Trauma in adults experiencing homelessness.

Jean-Philippe Miller1, Gerard M O' Reilly2, Jessica L Mackelprang3

  • 1Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia.

Injury
|March 10, 2020
PubMed
Summary

Homeless individuals presenting to trauma centers experience less severe injuries but higher rates of assault and self-harm. Improved identification and services are crucial for this vulnerable population.

Keywords:
Discharged against medical adviceHomelessnessInjuryInjury severity scoreMortalityPatient dischargePsychiatry

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Area of Science:

  • Trauma Surgery
  • Public Health
  • Epidemiology

Background:

  • Homeless populations face disproportionately higher health burdens.
  • Understanding trauma epidemiology in homeless individuals is critical for targeted interventions.

Purpose of the Study:

  • To describe the epidemiology of physical trauma in homeless patients at an urban trauma center.
  • To compare injury severity and outcomes between homeless and domiciled trauma patients.

Main Methods:

  • Retrospective matched cohort study (2010-2017) of adult trauma patients.
  • Primary homelessness identified via ICD-10 codes and address data.
  • Matched 1:2 ratio of homeless to domiciled patients based on age, sex, and injury timing.

Main Results:

  • Homeless patients (0.6% of registry) had lower median Injury Severity Scores (ISS) than domiciled patients (5 vs. 9, p < 0.001).
  • Homeless individuals showed higher rates of assault (32.1% vs. 9.5%), intentional self-harm (10.7% vs. 2.7%), and penetrating injuries (16.0% vs. 6.5%).
  • Higher rates of psychiatric admissions (9.2% vs. 0.8%) and discharging against medical advice (DAMA) were observed in homeless patients.

Conclusions:

  • Homelessness is linked to specific injury types (assault, self-harm, penetrating) and higher psychiatric admissions, despite lower overall injury severity.
  • Standardized documentation and variable definitions are needed to identify and support vulnerable homeless trauma patients.
  • Ensuring linkage to peripheral services is essential for improving care for homeless individuals presenting to trauma centers.