The Role of Psychiatry in the Management of Acute Trauma Surgery Patients

Abstract

Background: Trauma is a leading cause of death and disability in the United States, with high prevalence and recidivism in individuals with psychiatric and substance abuse disorders. Half of these disorders go undiagnosed by the trauma team, resulting in adverse public health and economic consequences.Method: In a 16-week pilot study in the emergency department of an inner-city tertiary care hospital, a psychiatrist was integrated into the trauma surgery team by responding to all traumas and rounding with the staff 1 shift per week (March 1, 2000, through June 31, 2000. During this 16-week period, 375 patients passed through the trauma surgery service. Data on the frequency of psychiatric consultations were compared with those for a retrospectively selected control group consisting of all 360 patients passing through the trauma surgery service during the corresponding 16 weeks of the previous year (March 1, 19991, , through June 31, 1999. To determine the prevalence of psychopathology, eligible patients seen during the psychiatrist's shift (N = 28) were assessed with a semistructured interview, and charts for eligible patients seen in the corresponding shift during the previous year (N = 18) were assessed according to the same criteria. Before the study, a 10-item, self-report questionnaire was completed by 16 (73%) of the 22 emergency medicine physicians who serve as front-line staff members. The survey assessed physicians' attitudes toward psychiatric consultation for psychopathology and addictions in trauma patients.Results: Based on DSM-IV screening criteria, the prevalence of preexisting psychopathology was 68% (19/28), but before the psychiatrist's involvement, only 12% (2/16) of physicians surveyed had considered consulting psychiatry, even for patients with gross psychopathology. Before the psychiatrist's integration into the 16-week study period, 75% (9/12) of trauma patients were discharged without psychiatric consultation despite the fact that more than half had documented substance abuse. After the psychiatrist joined the team, staff awareness of psychopathology sharpened. The number of patients treated for a psychiatric disorder that was often the proximal cause of the traumatic event nearly doubled, even on shifts not covered in the study.Conclusions: The ability to identify and treat coexisting psychopathology requires trauma surgeons to routinely incorporate a psychiatrist into their evaluation and treatment algorithm. Such a change in physician awareness and motivation hinges on a psychiatrist's visible presence (even if brief) and regular, active participation in the emergency department.

Frequency of Recidivism in Patients With Orthopedic Trauma

“…Opportunities for intervention include counseling, support groups, educational services, and treatment for mental illness. [20][21][22]26 It appears worthwhile to determine the cost-effectiveness of these strategies as well as their effect on personal well-being. Factors associated with recidivism included age younger than 40 years, unmarried status, unemployment, and substance use.…”

A mixed psychiatric and somatic care unit for trauma patients: 10 years of experience in an urban level I trauma center in the Netherlands

“…Limited literature is available on the topic of combined care at a MPU, while the number of this specific group of patients in need of this care is increasing [5,6,8,9]. 9% of all the patients referred to the MPU are trauma patients [7].…”

Impact of an opioid use disorder consult service on hospitalized trauma patients with opioid use disorder

“…The involvement of a designated, internal medicine-trained “trauma hospitalist” in a trauma team has also been shown to decrease mortality and readmission rates in medically complex patients 14 . More specific to addiction, the inclusion of a psychiatrist on trauma rounds resulted in a 10% increase in psychiatry consults for trauma patients with substance use disorders such as OUD 15 …”