The homeless orthopaedic trauma patient: follow-up, emergency room usage, and complications

J Orthop Trauma. 2014 Jun;28(6):e128-32. doi: 10.1097/BOT.0000000000000000.

Abstract

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.

MeSH terms

  • Adult
  • Ambulatory Care / statistics & numerical data*
  • Continuity of Patient Care / statistics & numerical data*
  • Databases, Factual
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Homeless Persons / statistics & numerical data*
  • Humans
  • Male
  • Medically Uninsured / statistics & numerical data
  • Middle Aged
  • Musculoskeletal System / injuries*
  • Retrospective Studies
  • Tennessee / epidemiology
  • Trauma Centers / statistics & numerical data
  • Wounds and Injuries / epidemiology*
  • Wounds and Injuries / surgery
  • Wounds and Injuries / therapy