Traumatic brain injury in the homeless: health, injury mechanisms, and hospital course

ABSTRACT

Primary Objective

Established literature demonstrates that homeless individuals experience both greater disease burden and risk of experiencing traumatic brain injury (TBI) than the general population. Similarly, shared risk factors for both homelessness and/or TBI may exacerbate the risk of repetitive neurotrauma within homeless populations.

Research Design

We leveraged a state-wide trauma registry, the Pennsylvania Trauma Outcome Study (PTOS), to characterize 609 patients discharged to homeless (58% TBI, 42% orthopedic injury (OI)) in comparison to 609 randomly sampled adult patients discharged to home.

Methods and Procedures

We implemented Chi-square tests to examine preexisting health conditions (PECs), hospital course, and injury mechanisms for both patient groups.

Main Outcomes and Results

Homelessness affects a greater proportion of nonwhite patients, and homeless patients present for care with increased frequencies of psychiatric and substance use PECs, and alcohol-positive TBI. Furthermore, assault impacts a larger proportion of homeless patients, and the window for overnight assault risk resulting in TBI is extended for these patients compared to patients discharged to home.

Conclusion

Given the shifting conceptualization of TBI as a chronic condition, identifying homeless patients on admission to trauma centers, rather than retrospectively at discharge, can enhance understanding of the challenges facing the homeless as they age with both a complex neurotrauma history and multimorbidity.

KEYWORDS:

• Traumatic brain injury
• homeless
• preexisting conditions
• race
• assault

Acknowledgments

The data presented here were provided by the Pennsylvania Trauma Systems Foundation, Mechanicsburg, Pennsylvania. The Foundation specifically disclaims responsibility for any analyses, interpretations, or conclusions. Credit must be given to the Pennsylvania Trauma Outcome Study (PTOS) as the source of the data, and we specifically thank Nathan McWilliams for his assistance in receiving this data.

Authors’ disclosure statement

The authors report no conflict of interest.

Author contributions statement

KD contributed to project conceptualization, data cleaning, analyses, and drafting of the manuscript, JS contributed to data acquisition, data cleaning, and drafting the manuscript, and FH assisted with project conceptualization, drafting the manuscript, and supervision of the project.

Additional information

Funding

This work was funded by the Pennsylvania Department of Health under Grant PA-DOH SAP#4100077082.