Falsgraf Erika, Inaba Kenji, de Roulet Amory, Johnson Megan, Benjamin Elizabeth, Lam Lydia, Matsushima Kazuhide, Strumwasser Aaron, Demetriades Demetrios
From the Keck School of Medicine of the University of Southern California (E.F., A.D.R., M.J.), Los Angeles, California; and Division of Acute Care Surgery and Surgical Critical Care (K.I., E.B., L.L., K.M., A.S., D.D.), LAC + USC Medical Center, Los Angeles, California.
J Trauma Acute Care Surg. 2017 Nov;83(5):882-887. doi: 10.1097/TA.0000000000001588.
Patients with psychiatric illness have been shown to experience higher rates of traumatic injury. Injury patterns, treatment decisions, and outcomes have not been well characterized in patients with psychiatric illness after injury, in particular those who undergo acute surgical intervention. The purpose of this analysis was to determine mortality, complications, and surgical intervention rates in patients with psychiatric illness after traumatic injury.
This is a retrospective study of trauma patients ≥18 years old admitted to LAC + USC Medical Center between January 2008 and March 2015. Patients with psychiatric diagnoses were identified using ICD-9 diagnosis codes. Multivariate logistic regression analyses taking into account demographic and injury characteristics were used to identify associations between psychiatric comorbidity, injury mechanism, surgical interventions, and outcomes in patients after injury.
A total of 26,502 patients were analyzed. Of these, 3,040 (11.5%) had a documented psychiatric comorbidity (2.0% depressive disorder, 0.8% bipolar disorder, 1.3% schizophrenia, 0.5% anxiety disorder, 3.2% substance use disorder). Patients with psychiatric illness were significantly older (49.6 years vs. 42.0 years, p < 0.001), had a lower proportion of penetrating injuries (13.8% vs. 18.1%, p < 0.001), and had a higher incidence of self-inflicted injuries (11.6% vs. 0.72%, p < 0.001). No difference in gender distribution was observed (74.2% men vs. 74.4% men, p = 0.80). Overall mortality was similar in both groups (adjusted odds ratio [aOR], 0.73; p = 0.07). Patients with psychiatric illness were significantly less likely to undergo acute surgical intervention within 6 hours of emergency department admission (aOR, 0.64; p < 0.001). Time from ED arrival to consent for acute surgical intervention was similar in both groups (94.8 min vs. 93.0 min, p = 0.84). No significant difference in mortality after acute surgical intervention was observed (aOR, 0.26; p = 0.10). Psychiatric illness was associated with a significantly higher likelihood of developing complications (aOR, 1.90; p < 0.001) and longer hospital lengths of stay (10.6 days vs. 6.2 days, p < 0.001).
Trauma patients with comorbid psychiatric illness were observed to have lower rates of acute surgical interventions, higher complication rates, and longer hospital lengths of stay. Further studies are needed to better characterize the causative factors underlying these associations.
Epidemiological, level III.
有证据表明，患有精神疾病的患者遭受创伤性损伤的几率更高。受伤后，尤其是那些接受急性外科手术干预的患有精神疾病的患者，其损伤模式、治疗决策和治疗结果尚未得到充分描述。本分析的目的是确定创伤性损伤后患有精神疾病的患者的死亡率、并发症发生率和外科手术干预率。
这是一项对2008年1月至2015年3月期间入住洛杉矶县+南加州大学医学中心的18岁及以上创伤患者的回顾性研究。使用ICD - 9诊断代码识别患有精神疾病诊断的患者。采用多因素逻辑回归分析，同时考虑人口统计学和损伤特征，以确定受伤后患者的精神疾病共病、损伤机制、外科手术干预与治疗结果之间的关联。
共分析了26502例患者。其中，3040例（11.5%）有记录的精神疾病共病（2.0%为抑郁症，0.8%为双相情感障碍，1.3%为精神分裂症，0.5%为焦虑症，3.2%为物质使用障碍）。患有精神疾病的患者年龄显著更大（49.6岁对42.0岁，p < 0.001），穿透性损伤比例更低（13.8%对18.1%，p < 0.001），且自残损伤发生率更高（11.6%对0.72%，p < 0.001）。性别分布无差异（男性占74.2%对男性占74.4%，p = 0.80）。两组总体死亡率相似（调整优势比[aOR]，0.73；p = 0.07）。患有精神疾病的患者在急诊科入院后6小时内接受急性外科手术干预的可能性显著更低（aOR，0.64；p < 0.001）。两组从急诊到达至同意进行急性外科手术干预的时间相似（94.8分钟对93.0分钟，p = 0.84）。急性外科手术干预后的死亡率无显著差异（aOR，0.26；p = 0.10）。精神疾病与发生并发症的可能性显著更高（aOR，1.90；p < 0.001）以及住院时间更长（10.6天对6.2天，p < 0.001）相关。
观察到患有合并精神疾病的创伤患者急性外科手术干预率更低、并发症发生率更高且住院时间更长。需要进一步研究以更好地描述这些关联背后的致病因素。
流行病学，三级。
