The Homeless Orthopaedic Trauma Patient: Follow-up, ER Usage, and Complications.

Objectives:

To review homeless patients with orthopaedic trauma injuries and examine their ER utilization, follow-up rates, and complication rates DESIGN:: Retrospective chart review.

Setting:

Patients presenting to a Level I trauma center with orthopaedic trauma injuries from 2001-2010.

Patients/participants:

Sixty-three uninsured, homeless patients and sixty-three uninsured, non-homeless patients with orthopaedic trauma injuries.

Intervention:

Homeless orthopaedic trauma patients were identified through ER intake sheets and CPT 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 non-homeless patients (p 0.001). There were no significant differences among the type of complications (none, infection, hardware failure, non-union) between the homeless and non-homeless patients (p = 0.23). Operative homeless patients returned to the orthopaedic clinic for follow-up more than non-operative homeless patients (M = 5.4, SD = 7.6; M = 1.2, SD = 1.5, respectively, p 0.001).

Conclusion:

Our data is the first to examine the problems associated with homelessness in the orthopaedic trauma patient and demonstrates an increased challenge in 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.