Clous Emile A, Beerthuizen Kimberly C, Ponsen Kees Jan, Luitse Jan S K, Olff Miranda, Goslings J Carel
From the Trauma Unit, Department of Surgery (E.C., K.B., J.L., C.G.), Academic Medical Center, Amsterdam, The Netherlands; Department of Surgery (K.J.P.), Medical Center Alkmaar, Alkmaar, The Netherlands; and Department of Psychiatry (M.O.), Academic Medical Center, Amsterdam, The Netherlands.
J Trauma Acute Care Surg. 2017 Apr;82(4):794-801. doi: 10.1097/TA.0000000000001371.
Suicide is currently a topic of high priority for policy-makers, researchers and clinicians. The World Health Organization estimated 804,000 suicide deaths worldwide in 2012. Some studies that focused on patients with self-inflicted injury revealed that mortality in this group is higher than for patients who sustain unintentional injury. However little is known about the impact of psychiatric disorders on health care resources including length of hospital stay.
To determine whether trauma patients with a psychiatric disorder or after attempting suicide are at higher risk of a complicated course than patients without a psychiatric disorder or accidental cause. The secondary objective was to provide an overview of the current literature on the same group of trauma patients with psychiatric comorbidity in regard to mortality rate, length of stay, hospital costs and quality of life. Our primary outcome measure, complicated course, was found to be most clinically relevant.
We searched PubMed, Embase and PsycInfo electronic databases. All searches were updated to March 2016. The methodological quality was assessed using the QUIPS tool.
Our search identified 9284 articles (PubMed 3660, Embase 2590, PsycInfo 3034). Of these, 18 articles were included. Four studies investigated the association between psychiatric disorders and a complicated course after trauma, three found a significant higher risk of complications. Mortality was reviewed in 14 studies, of which seven showed significant higher risk of in-hospital mortality for trauma patients with psychiatric disorder. Eight of nine studies found significant prolonged length of stay for these patients.
Patients who have a psychiatric disorder or who have attempted suicide are at higher risk of increased in-hospital mortality and prolonged length of stay after sustaining injuries. These patients also tend to be at higher risk of complications after severe trauma, however future research is needed to confirm these potentially important implications.
Systematic review, level III.
自杀目前是政策制定者、研究人员和临床医生高度关注的话题。世界卫生组织估计2012年全球有80.4万人自杀死亡。一些针对自残伤者的研究表明，该群体的死亡率高于意外伤害患者。然而，关于精神障碍对包括住院时间在内的医疗资源的影响，人们知之甚少。
确定患有精神障碍或自杀未遂的创伤患者是否比没有精神障碍或意外原因的患者有更高的复杂病程风险。次要目的是概述关于同一组患有精神疾病合并症的创伤患者的死亡率、住院时间、住院费用和生活质量的当前文献。我们发现主要结局指标复杂病程在临床上最为相关。
我们检索了PubMed、Embase和PsycInfo电子数据库。所有检索更新至2016年3月。使用QUIPS工具评估方法学质量。
我们的检索共识别出9284篇文章（PubMed 3660篇、Embase 2590篇、PsycInfo 3034篇）。其中，纳入了18篇文章。四项研究调查了精神障碍与创伤后复杂病程之间的关联，三项研究发现并发症风险显著更高。14项研究对死亡率进行了综述，其中7项研究表明患有精神障碍的创伤患者院内死亡风险显著更高。九项研究中的八项发现这些患者的住院时间显著延长。
患有精神障碍或自杀未遂的患者在受伤后有更高的院内死亡率和更长的住院时间风险。这些患者在严重创伤后也往往有更高的并发症风险，然而需要未来的研究来证实这些潜在的重要影响。
系统评价，III级。
