Disparities in triage and management of the homeless and the elderly trauma patient
Abstract Background Trauma 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. Methods A retrospective review of all trauma patients...
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| Format: | Article |
| Language: | English |
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BMC
2020-07-01
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| Series: | Injury Epidemiology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s40621-020-00262-1 |
| _version_ | 1818301458343264256 |
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| author | Kathryn B. Schaffer Jiayan Wang Fady S. Nasrallah Dunya Bayat Tala Dandan Anthony Ferkich Walter L. Biffl |
| author_facet | Kathryn B. Schaffer Jiayan Wang Fady S. Nasrallah Dunya Bayat Tala Dandan Anthony Ferkich Walter L. Biffl |
| author_sort | Kathryn B. Schaffer |
| collection | DOAJ |
| description | Abstract Background Trauma 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. Methods A 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. Results Of 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. Conclusions Homeless 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. |
| first_indexed | 2024-12-13T05:23:20Z |
| format | Article |
| id | doaj.art-84cd760d0e59493e8a6b1c02708b75b8 |
| institution | Directory Open Access Journal |
| issn | 2197-1714 |
| language | English |
| last_indexed | 2024-12-13T05:23:20Z |
| publishDate | 2020-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Injury Epidemiology |
| spelling | doaj.art-84cd760d0e59493e8a6b1c02708b75b82022-12-21T23:58:15ZengBMCInjury Epidemiology2197-17142020-07-017111010.1186/s40621-020-00262-1Disparities in triage and management of the homeless and the elderly trauma patientKathryn B. Schaffer0Jiayan Wang1Fady S. Nasrallah2Dunya Bayat3Tala Dandan4Anthony Ferkich5Walter L. Biffl6Trauma Service, Scripps Memorial Hospital La JollaTrauma Service, Scripps Memorial Hospital La JollaTrauma Service, Scripps Memorial Hospital La JollaTrauma Service, Scripps Memorial Hospital La JollaTrauma Service, Scripps Memorial Hospital La JollaTrauma Service, Scripps Memorial Hospital La JollaTrauma Service, Scripps Memorial Hospital La JollaAbstract Background Trauma 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. Methods A 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. Results Of 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. Conclusions Homeless 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.http://link.springer.com/article/10.1186/s40621-020-00262-1HomelessGeriatricTraumaTriageTrauma activationEmergency department |
| spellingShingle | Kathryn B. Schaffer Jiayan Wang Fady S. Nasrallah Dunya Bayat Tala Dandan Anthony Ferkich Walter L. Biffl Disparities in triage and management of the homeless and the elderly trauma patient Injury Epidemiology Homeless Geriatric Trauma Triage Trauma activation Emergency department |
| title | Disparities in triage and management of the homeless and the elderly trauma patient |
| title_full | Disparities in triage and management of the homeless and the elderly trauma patient |
| title_fullStr | Disparities in triage and management of the homeless and the elderly trauma patient |
| title_full_unstemmed | Disparities in triage and management of the homeless and the elderly trauma patient |
| title_short | Disparities in triage and management of the homeless and the elderly trauma patient |
| title_sort | disparities in triage and management of the homeless and the elderly trauma patient |
| topic | Homeless Geriatric Trauma Triage Trauma activation Emergency department |
| url | http://link.springer.com/article/10.1186/s40621-020-00262-1 |
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