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

Harrison F. Kay, Vasanth Sathiyakumar, Kristin R. Archer, Shannon L. Mathis, Jordan C. Apfeld, Young M. Lee, A. Alex Jahangir, Jesse Ehrenfeld, William T. Obremskey, Manish K. Sethi

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
JournalJournal of Orthopaedic Trauma
Volume28
Issue number6
DOIs
StatePublished - 2014
Externally publishedYes

Keywords

  • ancillary support
  • emergency room usage
  • follow-up
  • Homeless patients
  • nutrition
  • orthopaedic trauma
  • social work

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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