F. E. Scott1, D. Tatum1 1Our Lady of the Lake Regional Medical Center,Trauma Specialist Program,Baton Rouge, LA, USA
Introduction: Mental illness is a growing public health problem and an independent risk factor for unintentional injury. The CDC estimates that 26% of adults in the United States (US) will suffer mental illness this year and that half of all adults will develop at least one mental illness in their lifetime. Patients with psychiatric disorders have been shown to have higher risk of in-hospital mortality, more complicated clinical courses, and longer hospital stays compared to those without a pyschiatric disorder. Recent benchmarking data for US trauma centers revealed mental disorder incidence in trauma patients admitted to our institution to be higher than the mean reported incidence of all other reporting hospitals (14% vs 10%). We sought to identify those most at risk of unintentional injury in an adult, non-elderly population with history of mental illness.
Methods: All admissions from 2014 – 2016 in adults aged 18 – 64 years were identified in the trauma registry. Exclusions included eldery age (65+ years), dementia, prior TBI, history of substance or alcohol abuse alone, and intentional injury.
Results: Of 4270 patients included, 527 (12.4%) had a reported mental illness. Incidence increased from 11% in 2014 to 14% in 2016 (P = 0.02). Median age in the mental illness cohort was higher [44 (IQR 31 – 56) vs 36 (IQR 25 – 50); P<0.001], median hospital stay longer (5 (IQR 3 – 9) vs 4 (2 – 8); P<0.001], and Injury Severity Score (ISS) lower [9 (4 – 13) vs 9 (4 – 16), P = 0.013]. The percentage of females was significantly different between mentally ill and non-mentally ill (48% vs 24%, P<0.001). Race differed significantly (P<0.001), as the nonmentally ill group was 47% Caucasian/ 44% African American, while the mentally ill group was primarily Caucasian (73%). Mechanism of injury did not differ between the groups.
Conclusions: Incidence of patients presenting with unintentional injury in the setting of mental illness has increased significantly. Older, non-elderly adults, especially women, with mental illness are at significantly increased risk of injury by unintentional means. Longer LOS despite lower ISS may be due to difficulty in arranging appropriate discharge disposition or obtaining mental health resources, especially in Medicaid funded patients. Recognition of these risk factors should prompt targeting of injury prevention efforts and resources to the mentally ill.
