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

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.

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).

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.

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.