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- Title
Psychiatric comorbidity and trauma: impact on inpatient outcomes and implications for future management.
- Authors
Meyer, Maximilian Arthur; van den Bosch, Tijmen; Millenaar, Zita; Heng, Marilyn; Leenen, Loek; Hietbrink, Falco; Houwert, Roderick Marijn; Kromkamp, Marjan; Nelen, Stijn Diederik
- Abstract
Purpose: This study aimed to quantify the impact of pre-existing psychiatric illness on inpatient outcomes after major trauma and to assess acuity of psychiatric presentation as a predictor of outcomes. Methods: A retrospective single-center cohort study identified adult trauma patients with an Injury Severity Score (ISS) ≥ 16 between January 2018 and December 2019. Bivariate analysis assessed patient characteristics, injury characteristics, and injury outcomes between patients with and without psychiatric comorbidity. A sub-group analysis explored further effects of psychiatric history and need for inpatient psychiatric consultation on outcomes. Results: Of 640 patients meeting inclusion criteria, 99 patients (15.4%) had at least one psychiatric comorbidity. Patients with psychiatric comorbidity sustained distinct mechanisms of injury and higher in-hospital morbidity (44% vs. 26%, OR 1.97, 95% CI 1.17–3.3, p = 0.01), including pulmonary morbidity (31% vs. 21%, p < 0.01), neurologic morbidity (18% vs 7%, p < 0.01), and deep wound infection (8% vs. 2%, p < 0.01) than the control cohort. Psychiatric patients also had significantly greater median intensive care unit (ICU), length of stay (LOS) (1 day vs. 0 days, p = 0.04), median inpatient ward LOS (10 days vs. 7 days, p = 0.02), and median overall hospital LOS (16 days vs. 11 days, p < 0.01). In sub-group analysis, patients with a history of psychiatric illness alone had comparable outcomes to the control group. Conclusions: Psychiatric comorbidity negatively impacts inpatient morbidity and inpatient LOS. This effect is most pronounced among acute psychiatric episodes with or without a history of mental illness.
- Subjects
WOUNDS &; injuries; PSYCHIATRIC treatment; PREDICTION models; HOSPITAL care; MENTAL illness; DISEASE management; TREATMENT effectiveness; RETROSPECTIVE studies; SYMPTOMS; DESCRIPTIVE statistics; HOSPITAL mortality; WOUND infections; LONGITUDINAL method; ODDS ratio; MEDICAL records; ACQUISITION of data; STATISTICS; RESEARCH; INTENSIVE care units; CONFIDENCE intervals; LENGTH of stay in hospitals; COMPARATIVE studies; COMORBIDITY; MEDICAL referrals; EVALUATION
- Publication
European Journal of Trauma & Emergency Surgery, 2024, Vol 50, Issue 2, p439
- ISSN
1863-9933
- Publication type
Article
- DOI
10.1007/s00068-023-02359-w