Characteristics and Outcomes of Abdominal and Pelvic Trauma Patients With Psychiatric Illness

Gribben, Jeanie L.; Ilonzo, Nicole; Neifert, Sean N; Hubert, Maya; Leitman, I. Michael

doi:10.1016/j.jss.2019.05.051

Cited by 11 publications

(17 citation statements)

References 26 publications

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“…Similar patterns have been observed in prior investigations in trauma settings. 8 9 11 13 15 Of interest, however, while our study indicated that the subgroup of patients with mental disorders was less likely to have severe GCS scores, past studies have shown differing results. Falsgraf et al found that injured patients with psychiatric diagnoses had proportionally more severe GCS scores as compared with those without such diagnoses, while Perales-Villarroel et al found no differences in GCS scores between the two groups.…”

Section: Discussioncontrasting

confidence: 52%

“…This is similar to what has been reported in previous studies. 8 11 13 15 We found that trauma patients with mental disorders presented more often with severe injuries, were more likely to require admission to the TICU and MV, and experienced a longer duration of MV when compared with those without this comorbidity. Similar patterns have been observed in prior investigations in trauma settings.…”

Section: Discussionmentioning

confidence: 86%

“… 8 9 11 13 15 In-hospital mortality rates, by contrast, have not been conclusive as reports have shown conflicting results. 8 9 11 13 …”

Section: Introductionmentioning

confidence: 99%

“…2 3 Psychiatric illnesses have a significant impact on the clinical outcomes of patients, as they have been associated with increased morbidity, lower quality of healthcare, and worse health. [4][5][6][7][8][9][10] Moreover, individuals with mental disorders are at greater risk of unintentional injuries when compared with the general population. 4 11-13 Previous analyses have suggested that trauma patients with psychiatric disorders are more likely to suffer unintentional and self-inflicted injuries relative to those without these comorbid conditions.…”

Section: Introductionmentioning

confidence: 99%

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Epidemiology of trauma in patients with mental disorders

Muns

Ramos-Meléndez

Guerrios-Rivera

et al. 2022

Trauma Surg Acute Care Open

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ObjectivesWe aimed to explore the influence of mental disorders on the risk of developing complications and in-hospital mortality after trauma.MethodsWe conducted an institutional review board-approved cohort study of 23 500 adult patients admitted to the Puerto Rico Trauma Hospital from 2002 to 2019. Participants were divided into 2 groups according to the presence or absence of psychiatric illnesses. Logistic regressions were employed to investigate the effect of mental illness on study outcomes.ResultsPsychiatric illness was associated with higher risk of complications; this risk increased with age. The pattern was accentuated for those with substance use disorders (SUD) and attenuated for those with non-substance-related diagnoses (NSRD). Psychiatric patients with Glasgow Coma Scale (GCS) scores of 15 had a 42% (95% CI 1.17 to 1.73) higher risk of dying, while the opposite was seen for those with scores <15 (adjusted OR=0.79; 95% CI 0.64 to 0.99). SUD was associated with a 51% (95% CI 1.21 to 1.88) higher risk of death in patients with GCS scores of 15, while NSRD was linked to a 49% (95% CI 0.33 to 0.79) lower odds of death among subjects with scores <15.ConclusionsOur results suggest that trauma patients with SUD are at increased risk of developing complications and those with SUD and GCS scores of 15 are at increased risk of death. Mental health screening is an essential component of the management of trauma patients. Stratifying based on mental health disorders may be helpful during the clinical management of trauma patients, as those with SUD may benefit from more aggressive management.Level of evidenceLevel 4, prognostic and epidemiological study.Study typeOriginal retrospective cohort study.

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Section: Discussioncontrasting

confidence: 52%

Section: Discussionmentioning

confidence: 86%

“… 8 9 11 13 15 In-hospital mortality rates, by contrast, have not been conclusive as reports have shown conflicting results. 8 9 11 13 …”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Epidemiology of trauma in patients with mental disorders

Muns

Ramos-Meléndez

Guerrios-Rivera

et al. 2022

Trauma Surg Acute Care Open

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“…For a high-volume trauma center treating 3,000 patients per year, this translates to nearly two patients with co-occurring psychiatric illness per day or more, given the increased likelihood of trauma patients having a psychiatric diagnosis [2,3]. These patients are at increased risk for adverse outcomes and lengthier hospitalizations, ultimately increasing resource consumption [4][5][6][7][8]. Two studies, published more than 20 years ago, have evaluated hospital costs for trauma patients with psychiatric illness: Zatzick et al [8] and Lyons et al [9].…”

Section: Introductionmentioning

confidence: 99%

Early Psychiatric Consultation Is Associated With Decreased Cost and Length of Stay in the Patient Population at a Level I Trauma Center

Chavez¹,

Caplan²,

McKnight³

et al. 2021

Cureus

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IntroductionPsychiatric illness impacts nearly one-quarter of the US population. Few studies have evaluated the impact of psychiatric illness on in-hospital trauma patient care. In this study, we conducted a retrospective cohort study to evaluate hospital resource utilization for trauma patients with comorbid psychiatric illnesses. MethodologyTrauma patients admitted to a level I center over a one-year period were included in the study. Patients were categorized into one of three groups: (1) no psychiatric history or in-hospital psychiatric service consultation; (2) psychiatric history but no psychiatric service consultation; and (3) psychiatric service consultation. Time to psychiatric service consultation was calculated and considered early if occurring on the day of or the day following admission. Patient demographics, outcomes, and resource utilization were compared between the three groups. ResultsA total of 1,807 patients were included in the study (n = 1,204, 66.6% no psychiatric condition; n = 508, 28.1% psychiatric condition without in-hospital psychiatric service consultation; and n = 95, 5.3% inhospital psychiatric service consultation). Patients requiring psychiatric service consultation were the youngest (P < .001), with the highest injury severity (P = .024), the longest hospital length of stay (P < .001), and the highest median hospital cost (P < .001). Early psychiatric service consultation was associated with an average saving in-hospital length of stay of 2.9 days (P = .021) and an average hospital cost saving of $7,525 (P = .046). ConclusionOne-third of our trauma population had an existing psychiatric diagnosis or required psychiatric service consultation. Resource utilization was higher for patients requiring consultation. Early consultation was associated with a savings of hospital length of stay and cost.

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