Emerg Med J doi:10.1136/emermed-2012-201761
  • Original article

High rates of head injury among homeless and low-income housed men: a retrospective cohort study

  1. Jason T Ramsay3
  1. 1Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
  2. 2Centre for Research on Inner-City Health, St Michael's Hospital, Toronto, Ontario, Canada
  3. 3Health Studies Program, Department of Anthropology, University of Toronto Scarborough, Ontario, Canada
  1. Correspondence to Dr Tomislav Svoboda, St Michael's Hospital, Centre for Research on Inner-City Health, 30 Bond Street, Toronto, Ontario, Canada M5B 1W8; tomislav.svoboda{at}
  • Received 12 August 2012
  • Revised 28 March 2013
  • Accepted 1 April 2013
  • Published Online First 27 April 2013


Objective To examine the predictors and temporal patterns of head injury (HI) presentation in the emergency department among cohorts of homeless and low-income housed men.

Methods Retrospective review and logistic regression of HIs found in emergency department records for three groups of men, those: (1) who were chronically homeless with drinking problems (CHDP) (n=50), (2) in the general homeless population (GH) (n=60) and (3) in low-income housing (LIH) (n=59).

Results The proportion of individuals with non-minimal HIs documented in the previous year were 28%, 3% and 5% with annual rates of 0.47, 0.017 and 0.037 among the CHDP, GH and LIH groups (p<0.0001). In the multivariate model, independent associations with having an HI included: an HI in the previous year (OR 11.8, 95% CI 3.83 to 36.4), drug dependence (OR 3.67, 95% CI 1.11 to 12.13) and seizures (OR 3.50, 95% CI 1.13 to 10.90), while mood-disorders were protective. Homelessness had a crude risk increase of HI (OR 3.15, 95% CI 1.21 to 8.23) but was not significant in the multivariate model. Among those with HIs, chronic homelessness with drinking problems was associated with a higher rate of HI. With each successive HI, the time interval to another HI was 12 days shorter (p=0.0004). The chronic subdural haematoma incidence in the under-65-year-old CHDP group was 11 per 1000 (95% CI 2.8 to 45).

Conclusions Having an HI is better predicted by previous head injuries, drug dependence or a seizure disorder than a history of homelessness or alcohol dependence. HIs may become more frequent with time.

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Among patients with minor TBI (GCS 13-15) getting CT scans ≥ 24 hours after injury, what proportion have a traumatic finding?


0.5% - 43% response rate
3% - 41% response rate
10% - 16% response rate

Related original article: PCT head imaging in patients with head injury who present after 24 h of injury: a retrospective cohort study

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