Traumatic brain injury in the homeless: health, injury mechanisms, and hospital course

Established literature demonstrates that homeless individuals experience both greater disease burden and greater risk for experiencing traumatic brain injury (TBI) than the general population. Similarly, shared risk factors for both homelessness and/or TBI may exacerbate the risk for repetitive neurotrauma within homeless populations. We leveraged a state-wide trauma registry, the Pennsylvania Trauma Outcome Study (PTOS) to examine pre-existing health conditions (PECs), hospital course, and injury mechanisms for 609 patients discharged to homeless (58% TBI, 42% orthopedic injury (OI)) in comparison to 609 randomly sampled adult patients discharged to home. Aligning with previous research, homelessness affects a greater proportion of non-White patients, and homeless patients present for care with increased frequencies of psychiatric and substance use PECs, and alcohol-positive TBI. Furthermore, the risk for assault impacts a larger proportion of homeless patients, and critically, the window for overnight assault risk resulting in TBI is extended for these patients compared to patients discharged to home. Given the shifting conceptualization of TBI as a chronic condition, identifying homeless patients on admission to trauma centers, rather than retrospectively at discharge can enhance understanding of the challenges facing the homeless as they age with both a complex injury history (specifically TBI) and multimorbidity.