• J Orthop Trauma · Jun 2014

    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, and Manish K Sethi.
    • Vanderbilt Department of Orthopaedic Surgery, Vanderbilt Orthopaedic Institute, Center for Health Policy, Vanderbilt University, Nashville, TN.
    • J Orthop Trauma. 2014 Jun 1; 28 (6): e128-32.

    ObjectivesTo review homeless patients with orthopaedic trauma injuries and examine their emergency room (ER) usage, follow-up rates, and complication rates.DesignRetrospective chart review.SettingPatients presenting to a level 1 trauma center with orthopaedic trauma injuries from 2001 to 2010.Patients/ParticipantsSixty-three uninsured homeless patients and 63 uninsured nonhomeless patients with orthopaedic trauma injuries were included.InterventionHomeless patients with orthopaedic trauma were identified through ER intake sheets and current procedural terminology code searches.Main Outcome MeasurementsER usage, orthopaedic clinic follow-up, and complications.ResultsAfter 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).ConclusionsOur 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 EvidencePrognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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