Outcomes following Traumatic Brain Injury in the Homeless Population: a Retrospective Cohort Analysis

Introduction: The literature describing traumatic brain injury (TBI) outcomes in the homeless population is limited to studies with a small number of patients and primarily single-institution analyses. Moreover, studies do not control for co-morbidities and TBI severity when comparing the homeless and non-homeless populations. This study analyzed a national database to compare TBI outcomes between homeless and non-homeless populations.

Methods: TriNetX, a national network of de-identified patient records, was retrospectively queried using ICD-10 and CPT codes. The homeless cohort, defined by coding of Z59.0 within 1 year of TBI, included 3,275 adults, while the non-homeless group included 342,275 adults. Following a propensity-score matched analysis (PSM) based on demographics, co-morbidities, and TBI severity, there were 3,270 patients in each cohort. Outcomes were measured from the day of injury to 3 months post-injury.

Results: Following TBI, the homeless cohort had statistically significant decreased mortality (OR: 0.76, 95% CI: 0.64-0.89, p=0.001), surgical intervention rates (OR: 0.67, 95% CI: 0.58-0.77, p< 0.0001) including craniotomy and craniectomy (OR: 0.74, 95% CI: 0.61-0.89, p=0.002), hemiplegia (OR: 0.74, 95%CI: 0.59-0.94, p=0.013), cerebral edema (OR: 0.77, 95% CI: 0.68-0.87, p< 0.0001), ICU (OR: 0.86, 95% CI: 0.78-0.95, p=0.004), and outpatient service utilization (OR: 0.53, 95% CI: 0.48-0.59, p< 0.0001). The homeless cohort also had significantly increased incidence of coma (OR: 1.65, 95% CI: 1.49-1.82, p< 0.0001), utilization of emergency services (OR: 1.46, 95% CI: 1.32-1.61, p< 0.0001), in-hospital complications (OR: 1.17, 95% CI: 1.05-1.30), p=0.004), seizures (OR: 1.25, 95% CI: 1.08-1.44, p=0.002), chronic pain (OR: 1.37, 95% CI: 1.20-1.58, p< 0.0001), opioid prescription (OR: 1.14, 95% CI: 1.02-1.27, p=0.022), and cognitive/linguistic symptoms post-TBI(OR: 1.25, 95% CI: 1.10-1.41, p< 0.0001).

Conclusion : There are significant differences in TBI outcomes and medical service utilization rates between the homeless and non-homeless populations. These findings indicate the need for targeted interventions for the homeless population during hospitalization and post-discharge to improve outcomes following TBI.