An Experience of Management of Homeless Neurosurgical Patients

  • Kim, Dae-Ki (Department of Neurosurgery National Medical Center) ;
  • Jwa, Cheol-Su (Department of Neurosurgery National Medical Center) ;
  • Kim, Gang-Hyeon (Department of Neurosurgery National Medical Center) ;
  • Kang, Jae-Kyu (Department of Neurosurgery National Medical Center)
  • Published : 2007.09.28

Abstract

Objective : Homeless patients probably have epidemiologic features that are different from those of general population. However, there have been no published articles about clinical characteristics of neurosurgical homeless patients. The authors tried to assess the clinical characteristics and treatment outcome of homeless neurosurgical patients. Methods : We retrospectively reviewed the medical records and radiological films of 76 homeless patients and 72 non-homeless patients following head trauma who were admitted to our neurosurgical department between June 2001 and June 2005. We compared two groups of the patients with the demographics, the clinical and laboratory characteristics. Also, 3D-day mortality was determined according to Glasgow Coma Scale (GCS) score. Results : Age of homeless patients was younger than that of non-homeless patients. Homeless patients had previous craniotomy evidences in skull x-rays more frequently (10.5% vs. 1.4%). Acute subdural hematoma was the most common type of head injury in the two groups. Moderate and severe head injury, based on GCS score on admission was more frequent in homeless patients (64% vs. 39%). Fifty percent of homeless patients underwent operation for traumatic head injury. However, 3D-day mortality according to GCS score was not significantly higher in homeless patients. Conclusion : Most homeless neurological patients were relatively young men. Also, moderate or severe brain injuries were observed more frequently. However, mortality rate of homeless patients in neurosurgical field is not significantly higher in the present study.

Keywords

References

  1. Boivin JF, Roy E, Haley N, Galbaud du Fort G : The health of street youth : a Canadian perspective. Can J Public Health 96 : 432-437, 2005
  2. Crowe C, Hardill K : Nursing research and political change : the street health report. Can Nurse 89 : 21-24, 1993
  3. Fischer PJ, Breakey WR : The epidemiology of alcohol, drug, and mental disorders among homeless persons. Am Psychologist 46 : 1115-1128, 1991 https://doi.org/10.1037/0003-066X.46.11.1115
  4. Galperim B, Cheinquer H, Stein A, Fonseca A, Lunge V, Ikuta N : Prevalence of hepatitis C virus in alcoholic patients : role of parenteral risk factors. Arq Gastroenterol 43 : 81-84, 2006 https://doi.org/10.1590/S0004-28032006000200004
  5. Han OS, Hong JP, Ha JH : Prevalence of mental disorder and quality of life among the homeless people in a city shelter. J Kor Neuropsychiatr Assoc 40 : 804-811, 2001
  6. Hwang SW : Mortality among men using homeless shelters in Toronto, Ontario. JAMA 283 : 2152-2157, 2000 https://doi.org/10.1001/jama.283.16.2152
  7. Jencks C : The Homeless. Cambridge (MA) : Harvard University Press : 1994
  8. Kim DH, You EY, Jung SK, Rhee JE, Suh GJ, Youn YK : The clinical analysis of th homeless visiting emergency medical centers. J Korean Soc Emerg Med 13 : 294-299, 2002
  9. Kim JC, Kim EJ, Ko SD : Descriptive Characteristics of the Homeless in Korea. Korean J Public Health 2 : 38-52, 2001
  10. Lecomte T, Mizrahi A : Recourse to care and morbidity of the homeless in the Paris district. Bull Acad Natl Med 181 : 1715-1727, 1997
  11. Nelson JA, Wright J : Sexually transmitted diseases and street youth : rates and interventions at a clinic in New York City. SIECUS Rep August/September : 8-10, 1994
  12. Noell J, Rohde P, Ochs L, Yovanoff P, Alter MJ, Schmid S, et al : Incidence and prevalence of chlamydia, herpes, and viral hepatitis in a homeless adolescent population. Sex Transm Dis 28 : 4-10, 2001 https://doi.org/10.1097/00007435-200101000-00003
  13. North CS, Thompson SJ, Pollio DE, Ricci DA, Smith EM : A diagnostic comparison of homeless and nonhomeless patients in an urban mental health clinic. Soc Psychiatry Psychiatr Epidemiol 32 : 236-240, 1997 https://doi.org/10.1007/BF00788244
  14. Padgett DK, Struening EL, Andrews H, Pittman J : Predictors of emergency room use by homeless adults in New York City : the influence of predisposing, enabling and need factors. Soc Sci Med 41 : 547-556, 1995 https://doi.org/10.1016/0277-9536(94)00364-Y
  15. Rotheram-Borus MJ, Koopman C, Haignere C, Davies M : Reducing HIV sexual risk behaviors among runaway adolescents. JAMA 266 : 1237-1241, 1991 https://doi.org/10.1001/jama.266.9.1237
  16. Roy E, Boivin JF, Haley N, Lemire N : Mortality among street youth. Lancet 352 : 32, 1998
  17. Shin HR, Hwang SY, Nam CM : The prevalence of hepatitis C virus infection in Korea : Pooled Analysis. J Korean Med Sci 20 : 985-988, 2005 https://doi.org/10.3346/jkms.2005.20.6.985
  18. Soliman AE, Reza H : Risk factors and correlates of violence among acutely ill adult psychiatric inpatients. Psychiatr Serv 52 : 75-80, 2001 https://doi.org/10.1176/appi.ps.52.1.75
  19. Vacha EF, Marin MV : Informal shelter providers : low income households sheltering the homeless. J Soc Distress Homeless 2 : 117-133, 1993 https://doi.org/10.1007/BF01074225
  20. Wolff N, Helminiak TW, Morse GA, Calsyn RJ, Klinkenberg WD, Trusty ML : Cost-effectiveness evaluation of three approaches to case management for homeless mentally ill clients. Am J Psychiatry 154 : 341-348, 1997 https://doi.org/10.1176/ajp.154.3.341
  21. Wood D : Delivering health care to homeless persons. The diagnosis and management of medical and mental health conditions. New York : Springer Publishing, 1992
  22. Wright JD, Knight JW, Weber-Burbin E, Lam J : Ailments and alcohol : Health status among the drinking homeless. Alcohol Health Res World 11 : 22-27, 1987