OTA International The Open Access Journal of Orthopaedic Trauma · July 20, 2026 · LoE III
Despite lower fracture rates, homeless patients have worse outcomes after geriatric ground-level falls: an analysis of National Trauma Data Bank
Kinsley Wang, Angeli Sirilan, Rose Zach, Annie Jia, Nimit Agarwal, Niloofar Dehghan — University of Phoenix
This retrospective cohort study used the National Trauma Data Bank (2021-2022) to compare outcomes after ground-level falls in 1,136 homeless versus 325,267 housed adults aged 50 and older. Despite being younger and having significantly lower fracture rates (51.2% vs 59.3%), homeless patients had worse outcomes: longer hospital stays (8.82 vs 6.63 days), more ICU admissions (25.3% vs 19.8%), and more complications (11.5% vs 6.3%), with homelessness independently associated with 1.5-fold higher odds of extended length of stay after adjusting for comorbidities and injury severity.
AI summary · from the full text · reviewed by Pukhraj Gaheer, Medical Student, Queen's University before publishing
Why it mattersThis highlights that housing status is an independent driver of trauma outcomes and resource utilization, prompting orthopaedic trauma teams to consider social determinants of health in discharge planning for geriatric fall patients.
Conclusion strengthConfirms prior evidence
Fragility index 59 and first evidence on the question, offset by no power calculation.
Presenting this at rounds? Start here
- ?The homeless cohort had substantial missing/underdocumented comorbidity data and lacked frailty scoring; how might unmeasured confounding (e.g., undiagnosed chronic disease, injury severity misclassification) affect the interpretation of the adjusted odds ratio for extended length of stay?
- ?Given that homeless patients were more likely to be discharged home or leave against medical advice rather than to skilled nursing facilities, how should orthopaedic trauma services adapt discharge planning and follow-up care pathways for this population?