Citation

Kiwanuka H, Maan Z, Rochlin D, Curtin C, Karanas Y, Sheckter CC. J. Burn Care Res. 2019; 40(5): 633-638.

Affiliation

Division of Plastic & Reconstructive Surgery. Stanford University. Stanford, CA.

Copyright

(Copyright © 2019, American Burn Association, Publisher Lippincott Williams and Wilkins)

DOI

10.1093/jbcr/irz045

PMID

30938433

Abstract

INTRODUCTION: Burn injuries are common in the homeless population. Little is known regarding whether homeless patients experience different outcomes when admitted for burns. We aim to 1) characterize the admitted homeless burn population, and 2) investigate differences in inpatient outcomes between the homeless and non-homeless populations.

METHODS: A retrospective cohort study was performed utilizing the Nationwide Inpatient Sample. Adult patients with complete data for burn characteristics were extracted. Variables included demographic, burn, and facility characteristics. Homelessness was identified with International Classification of Disease 9th edition codes. Outcomes were modeled with regression analysis and included length of stay, total operations, charges, disposition, and patient safety indicators.

RESULTS: 43,872 encounters were included of which 0.76% were homeless. Homeless encounters were more likely to be male (p<0.001) and Medicaid-insured (p<0.001). Flame and frostbite injuries were more likely (p<0.001), and the mean %TBSA was smaller (15.0 versus 16.8, p<0.001). After adjustment, homeless patients had greater lengths of stay (11.5 vs. 9.6, p=0.046), greater charges ($73,597 vs. $66,909, p=0.030), fewer operations (p=0.016), and three times higher likelihood leaving against medical advice (p=0.002). There was no difference in patient safety indicators or mortality.

CONCLUSION: Homeless burn admissions represent a unique cohort that carries a higher comorbidity burden and experiences longer lengths of stay with greater difficulty in disposition. Ironically, these patients accumulate more charges with limited means to pay. Even though no differences were observed in patient safety indicators or mortality, further research is needed to understand how the challenges within this population affect their recovery.

© American Burn Association 2019. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Language: en

Keywords

burn; homeless; homelessness