Department of Surgery, Section Trauma Surgery, Amsterdam University Medical Center, Location VUmc, P.O. Box 7057, 1007 MB, Amsterdam, The Netherlands.
Department of Hospital Psychiatry, Amsterdam University Medical Center, Location VUmc, Amsterdam, The Netherlands.
Eur J Trauma Emerg Surg. 2020 Oct;46(5):1159-1165. doi: 10.1007/s00068-019-01088-3. Epub 2019 Feb 15.
A medical-psychiatric unit (MPU) is a special ward where staff is trained in caring for patients with psychiatric or behavioural problems that need hospitalisation for physical health problems. It is well known that these patients are at higher risk of complications and have a longer length of stay resulting in higher costs than patients without psychiatric comorbidity. The objective of this study was to analyse the trauma patient population of the first 10 years of existence of the MPU in a level I trauma center.
A retrospective analysis was performed in 2-year cohorts from 2006 to 2016. All trauma patients admitted to the MPU were compared with the overall trauma patient population in VUmc. Data (psychiatric diagnosis, substance abuse, trauma scores, surgical interventions, complications, mortality) were extracted from individual patient notes and the Regional Trauma Registry.
258 patients were identified. 36% of all patients had a history of previous psychiatric admission and 30% had attempted suicide at least once in their lifetime. Substance abuse was the most common psychiatric diagnosis (39%), with psychotic disorder (28%) in second place. The median hospital stay was 21 days. Median MPU length of stay was 10 days (range 1-160). Injuries were self-inflicted in 57%. The most common mechanism of injury was fall from height with intentional jumping in second place. Penetrating injury rate was 24% and 33% had an ISS ≥ 16, compared to 5% and 15%, respectively, in the overall trauma patient population. The most common injuries were those of the head and neck. Complication rate was 49%.
Trauma patients that were admitted to the MPU of an urban level I trauma center had serious psychiatric comorbidity as well as high injury severity. Penetrating injury was much more common than in the overall trauma patient population. A high complication rate was noted. The high psychiatric comorbidity and the complicated care warrants combined psychiatric and somatic (nursing) care for this subpopulation of trauma patients. This should be taken into account in the prehospital triage to a trauma center. The institution of a MPU in level I trauma centers is recommended.
医疗-精神科病房（MPU）是一个特殊病房，其工作人员接受过护理有精神或行为问题的患者的培训，这些患者需要住院治疗身体疾病。众所周知，与没有精神共病的患者相比，这些患者并发症风险更高，住院时间更长，导致成本更高。本研究的目的是分析一级创伤中心 MPU 成立 10 年来的创伤患者人群。
对 2006 年至 2016 年的 2 年队列进行回顾性分析。将入住 MPU 的所有创伤患者与 VUmc 的总体创伤患者人群进行比较。从患者病历和区域创伤登记处提取数据（精神科诊断、药物滥用、创伤评分、手术干预、并发症、死亡率）。
共确定 258 名患者。所有患者中有 36%有既往精神科住院史，30%至少有过一次自杀未遂史。药物滥用是最常见的精神科诊断（39%），其次是精神病性障碍（28%）。中位住院时间为 21 天。MPU 中位住院时间为 10 天（范围 1-160 天）。损伤为自伤，57%为故意跳伤。最常见的损伤机制是高处坠落，其次是故意跳下。穿透性损伤率为 24%，ISS≥16 的比例为 33%，而总体创伤患者人群中的比例分别为 5%和 15%。最常见的损伤是头颈部损伤。并发症发生率为 49%。
入住城市一级创伤中心 MPU 的创伤患者有严重的精神共病，且损伤严重程度高。穿透性损伤比总体创伤患者人群更常见。并发症发生率高。高度的精神共病和复杂的护理需要为这一创伤患者亚群提供精神和躯体（护理）的联合治疗。这应在创伤中心的院前分诊中考虑。建议在一级创伤中心设立 MPU。
