Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Orthopedic Surgery, Massachusetts General Hospital, 55 Fruit Street, White Building 535, Boston, MA, 02114, USA.
Eur J Trauma Emerg Surg. 2024 Apr;50(2):439-446. doi: 10.1007/s00068-023-02359-w. Epub 2023 Sep 11.
This study aimed to quantify the impact of pre-existing psychiatric illness on inpatient outcomes after major trauma and to assess acuity of psychiatric presentation as a predictor of outcomes.
A retrospective single-center cohort study identified adult trauma patients with an Injury Severity Score (ISS) ≥ 16 between January 2018 and December 2019. Bivariate analysis assessed patient characteristics, injury characteristics, and injury outcomes between patients with and without psychiatric comorbidity. A sub-group analysis explored further effects of psychiatric history and need for inpatient psychiatric consultation on outcomes.
Of 640 patients meeting inclusion criteria, 99 patients (15.4%) had at least one psychiatric comorbidity. Patients with psychiatric comorbidity sustained distinct mechanisms of injury and higher in-hospital morbidity (44% vs. 26%, OR 1.97, 95% CI 1.17-3.3, p = 0.01), including pulmonary morbidity (31% vs. 21%, p < 0.01), neurologic morbidity (18% vs 7%, p < 0.01), and deep wound infection (8% vs. 2%, p < 0.01) than the control cohort. Psychiatric patients also had significantly greater median intensive care unit (ICU), length of stay (LOS) (1 day vs. 0 days, p = 0.04), median inpatient ward LOS (10 days vs. 7 days, p = 0.02), and median overall hospital LOS (16 days vs. 11 days, p < 0.01). In sub-group analysis, patients with a history of psychiatric illness alone had comparable outcomes to the control group.
Psychiatric comorbidity negatively impacts inpatient morbidity and inpatient LOS. This effect is most pronounced among acute psychiatric episodes with or without a history of mental illness.
本研究旨在量化先前存在的精神疾病对重大创伤后住院患者结局的影响，并评估精神疾病发作的严重程度作为结局的预测指标。
一项回顾性单中心队列研究纳入了 2018 年 1 月至 2019 年 12 月间损伤严重度评分（ISS）≥16 的成年创伤患者。采用双变量分析评估了伴有和不伴有精神疾病合并症的患者的患者特征、损伤特征和损伤结局。亚组分析进一步探讨了精神疾病史和住院精神科会诊的需求对结局的影响。
在符合纳入标准的 640 例患者中，有 99 例（15.4%）至少有 1 种精神疾病合并症。有精神疾病合并症的患者有不同的损伤机制，且院内发病率更高（44% vs. 26%，OR 1.97，95%CI 1.17-3.3，p=0.01），包括肺部发病率（31% vs. 21%，p<0.01）、神经系统发病率（18% vs. 7%，p<0.01）和深部伤口感染（8% vs. 2%，p<0.01）。与对照组相比，精神病患者的 ICU 和住院时间中位数（1 天 vs. 0 天，p=0.04）、住院病房 LOS 中位数（10 天 vs. 7 天，p=0.02）和总住院 LOS 中位数（16 天 vs. 11 天，p<0.01）也显著增加。在亚组分析中，仅有精神疾病史的患者与对照组的结局相似。
精神疾病合并症对住院发病率和住院 LOS 有负面影响。这种影响在伴有或不伴有精神病史的急性精神发作中最为明显。
