R. E. Plevin1, A. Conroy1, C. Juillard1, M. M. Knudson1, R. A. Callcut1 1San Francisco General Hospital And The University Of California, San Francisco,Department Of Surgery,San Francisco, CALIFORNIA, USA
Introduction:
Mental illness is a significant public health concern in the United States, where 20% of adults carry a mental health diagnosis and 5% have been diagnosed with severe mental illness. Those with mental illness are predisposed to sustaining both intentional and unintentional injuries, but the impact of mental illness on trauma outcomes is largely unknown. In 2012, the National Trauma Data Bank (NTDB) introduced a comorbidity of ‘Major Psychiatric Illness.’ We hypothesize that this vulnerable population is at greater risk of post-traumatic complications and consume more hospital resources compared to injured patients without mental illness.
Methods:
This is a retrospective cohort study of data from the 2012 National Sample Program (NSP) of the NTDB. Trauma patients were stratified into those with and without a diagnosed mental illness. Patients with self-inflicted injuries, those who died in the emergency room (ER), and those who were discharged or transferred directly from the ER to another facility were excluded. Patients were analyzed with respect to demographics, mechanism of injury, discharge disposition, length of stay, complications, and mortality. Multivariable regression analysis was performed to examine predictors of prolonged length of stay (LOS) and the impact of mental illness on complications.
Results:
In 2012, 146,069 patients who met the inclusion criteria were recorded in the NSP representing 633,007 injuries nationally after sample weighting. Approximately 6.9% of patients had a mental illness. Patients with mental illness were older and had more medical comorbidities. They were also more likely to be admitted to the hospital after a fall (51% vs. 41%, p < 0.01) and less likely to sustain trauma related to motor vehicles (37% vs. 29%, p < 0.01). Despite having lower injury severity scores (ISS, 10.8 vs. 11.7 p < 0.01) and mortality (1.8% vs. 2.7%, p < 0.01), patients with mental illness underwent more procedures (6.2 vs. 5.3, p < 0.05), had a longer LOS (6.9 days vs. 5.9 days, p < 0.05), and were more often discharged to a skilled nursing facility (SNF) or other inpatient facility (34% vs. 25%, p < 0.05). On logistic regression analysis, mental illness was an independent predictor for the development of pneumonia (p < 0.05), acute respiratory distress syndrome (ARDS, p < 0.05), urinary tract infection (UTI, p < 0.05), and acute renal failure (ARF, p < 0.05).
Conclusion:
Compared to patients without such illness, the injured mentally ill are at greater risk of developing post-traumatic complications, have longer hospital stays, and are more likely to be discharged to a SNF or other inpatient facility despite lower injury severity. Future investigations are needed to better understand the etiology of these complications while primary injury prevention efforts should be directed toward methods that are effective in this vulnerable population.