American journal of surgery · 2025
Examining disparities in management and outcomes among unhoused patients with traumatic brain injury.
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Kim Sean, Park Stephen, Forman Steven, Gallagher Shea, Ugarte Chaiss, Clark Damon, Martin Matthew, Inaba Kenji, Matsushima Kazuhide
Аннотация
OBJECTIVE: This study aims to investigate any differences in management and hospital outcomes between unhoused and housed patients with traumatic brain injury (TBI).
METHODS: We conducted a 3-year retrospective study (2019-2021). Patients with a head Abbreviated Injury Scale≥3 were included and divided into two cohorts: unhoused (UH) and housed underinsured (HUI). Logistic regression assessed the association between the unhoused status and our study outcomes.
RESULTS: A total of 1172 patients were identified. There was no significant difference in the rate of acute interventions for TBI, including intracranial pressure monitoring and neurosurgical procedures. Unhoused status was associated with a lower rate of withdrawal of care (3.7 % vs. 11.1 %, p = 0.012). After adjusting for confounding factors, UH patients had increased odds of brain death (adjusted odds ratio [AOR]:8.54, p < 0.001) and prolonged ventilator days (AOR:3.62, p = 0.048).
CONCLUSION: Our results suggest that unhoused status may have an influence on end-of-life medical decisions following TBI.
METHODS: We conducted a 3-year retrospective study (2019-2021). Patients with a head Abbreviated Injury Scale≥3 were included and divided into two cohorts: unhoused (UH) and housed underinsured (HUI). Logistic regression assessed the association between the unhoused status and our study outcomes.
RESULTS: A total of 1172 patients were identified. There was no significant difference in the rate of acute interventions for TBI, including intracranial pressure monitoring and neurosurgical procedures. Unhoused status was associated with a lower rate of withdrawal of care (3.7 % vs. 11.1 %, p = 0.012). After adjusting for confounding factors, UH patients had increased odds of brain death (adjusted odds ratio [AOR]:8.54, p < 0.001) and prolonged ventilator days (AOR:3.62, p = 0.048).
CONCLUSION: Our results suggest that unhoused status may have an influence on end-of-life medical decisions following TBI.