M. Harfouche1, M. Mazzei1, J. Beard1, L. Mason1, Z. Maher1, E. Dauer1, L. Sjoholm1, T. Santora1, A. Goldberg1, A. Pathak1 1Temple University,Trauma,Philadelpha, PA, USA
Introduction: The relationship between behavioral health disorders (BHDs) and outcomes after traumatic injury is not well understood and the data is evolving. The objective of this study was to evaluate the association between BHDs and outcomes such as mortality, length of stay (LOS), and inpatient complications in the trauma patient population.
Methods: We performed a review of the Trauma Quality Improvement Program (TQIP) database from the years 2013 to 2016 comparing patients with and without a BHD. Patients were classified as having a BHD if they had a comorbidity listed as a psychiatric disorder, alcohol abuse, drug abuse, dementia, and attention deficit hyperactivity disorder (ADHD). Psychiatric disorder included major depressive disorder, bipolar disorder, schizophrenia, anxiety/panic disorder, borderline or antisocial personality disorder and/or adjustment disorder/post-traumatic stress disorder. Descriptive statistics were performed and multivariable regression examined mortality, LOS, and inpatient complications. Statistics were performed using Stata/IC v15.
Results: In the study population, 254,882 (25%) patients were reported to have a BHD. Of these, psychiatric disorders were most prevalent at 38.3% (n=97,668) followed by alcohol abuse (33.3%, n=84,845), substance abuse (26.4%, n=67,199), dementia (20.2%, n=51,553), and ADHD (1.7%, n= 4,301). There was no difference in age between the groups (mean 44.1 v 44.3 in BHD v non-BHD groups), however, the BHD group was more likely to be female (38.4% v 37.4%, OR 1.04, CI 1.03-1.05, p<0.001). The overall mortality was lower in the BHD group (OR 0.81, CI 0.79-0.83 p<0.001) when controlling for age, gender, race, injury severity score and non-BHD comorbidities such as stroke, chronic obstructive pulmonary disease, congestive heart failure, diabetes and hypertension. Within the BHD group, patients with dementia had an increased likelihood of mortality when controlling for other risk factors (OR 1.62, CI 1.56-1.69, p<0.001). LOS was 8.4 days (s=0.02) for patients with a BHD versus 7.3 days (s=0.01) for patients without a BHD (p<0.001). Comorbid BHD was significantly associated with any inpatient complication (OR 1.19, CI 1.18-1.20, p<0.001). Select complications are presented in Table 1.
Conclusion: Trauma patients with a BHD have a lower overall mortality risk when compared to those without a BHD. However, subgroup analysis revealed that among patients with a BHD, those with dementia have an increased mortality risk. BHD increased risk for any inpatient complication overall and prolonged the LOS. Further study is needed to define and understand the risk factors for these associations.
