ArticleInjury epidemiology2020
Disparities in triage and management of the homeless and the elderly trauma patient.
Article in Injury epidemiology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
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Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Systematic review and meta-analysis of machine learning models predicting massive hemorrhage protocol in trauma.Scientific reports · 2026Pooled it
- Patterns of alcohol and drug screening in trauma patients: understanding housing status as a determinant of care.Injury epidemiology · 2026Article
- Comparison of Unhoused and Domiciled Patients Evaluated for Trauma in a Level II Trauma Center.The western journal of emergency medicine · 2026Article
- Utility of an Artificial Intelligence Language Model for Post-Operative Patient Instructions Following Facial Trauma.Craniomaxillofacial trauma & reconstruction · 2024Article
- Morbidity and Length of Stay After Injury Among People Experiencing Homelessness in North America.JAMA network open · 2024Article
- Prospective validation of a hospital triage predictive model to decrease undertriage: an EAST multicenter study.Trauma surgery & acute care open · 2024Article
- Resource Deployment in Response to Trauma Patients.Cureus · 2023Article
- Health disparities in orthopedic trauma: a qualitative study examining providers' perspectives on barriers to care and recovery outcomes.Social work in health careArticle
Corrections and comments
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Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundTrauma systems are designed to provide specialized treatment for the most severely injured. As populations change, it is imperative for trauma centers to remain dynamic to provide the best care to all members of the community.
methodsA retrospective review of all trauma patients treated at one Level II trauma center in Southern CA over 5 years. Three cohorts of patients were studied: geriatric (> 65 years), the homeless, and all other trauma patients. Triage, hospitalization, and outcomes were collected and analyzed.
resultsOf 8431 patients treated, 30% were geriatric, 3% homeless and 67% comprised all other patients. Trauma activation criteria was met for 84% of all other trauma patients, yet only 61% of homeless and geriatric patients combined. Injury mechanism for homeless included falls (38%), pedestrian/bicycle related (27%) and assaults (24%), often while under the influence of alcohol and drugs. Average length of hospital stay (LOS) was greater for homeless and geriatric patients and frequently attributed to discharge planning challenges. Both the homeless and geriatric groups demonstrated increased complications, comorbidities, and death rates.
conclusionsHomeless trauma patients reflect similar challenges in care as with the elderly, requiring additional resources and more complex case management. It is prudent to identify and understand the issues surrounding patients transported to our trauma center requiring a higher level of care yet are under-triaged upon arrival to the Emergency Department. Although a monthly review is done for all under-triaged patients, and geriatric patients are acknowledged to be a cohort continually having delays, the homeless cohort continues to be under-triaged. The admitted homeless trauma patient has similar complex case management issues as the elderly related to pre-existing health issues and challenges with discharge planning, both which can add to longer lengths of hospital stay as compared to other trauma patients. Given the lack of social support that is endemic to both populations, these cohorts represent a unique challenge to trauma centers. Further research into specialized care is required to determine best practices to address disparities evident in the homeless and elderly, and to promote health equity in marginalized populations.
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