Factors Associated With Psychiatry Consultation for Musculoskeletal Trauma Patients

Area of Science:

• Psychiatry
• Orthopedics
• Trauma Care

Background:

• Musculoskeletal trauma patients often present with complex mental health needs.
• Early identification and intervention for psychiatric comorbidities can impact recovery.
• The role of surgeons in initiating psychiatric consultations requires further understanding.

Purpose of the Study:

• To identify factors influencing musculoskeletal surgeons' recommendations for psychiatric consultations in trauma patients.
• To explore the specific patient variables and psychiatric conditions that prompt surgical referrals.

Main Methods:

• An online, survey-based experiment was conducted.
• Musculoskeletal surgeons (n=243) and consult-liaison psychiatrists (n=18) evaluated 5 hypothetical patient scenarios.
• Participants indicated whether a psychiatry consultation was recommended based on randomized patient variables.

Main Results:

• Factors associated with recommending consultation included younger patient age, psychiatric history, antipsychotic use, and scenarios involving psychosis, suicidality, substance withdrawal hallucinations, or impaired consent.
• Sadness alone did not significantly influence consultation recommendations.
• Surgeons' recommendations were influenced by the severity of psychiatric symptoms presented.

Conclusions:

• Musculoskeletal surgeons consider severe psychiatric conditions when recommending consultations.
• Collaboration between surgeons and psychiatrists is crucial for comprehensive trauma patient care.
• Addressing pressing mental health needs, including psychosis and suicidality, should be prioritized, with potential for later management of mood or anxiety symptoms impacting recovery.