Impact of Pre-existing Psychiatric Conditions on Trauma Outcomes: A National Analysis

Understanding the impact of psychiatric pre-existing conditions (PsyPECs) on trauma outcomes is crucial, as trauma is the leading cause of mortality for Americans aged 1-45. Although previous regional studies have shown higher mortality rates and longer hospital length of stay (H-LOS) for injured patients with PsyPECs, this has not been studied at the national level. The purpose of this study is to identify the PsyPECs associated with mechanism of injury and other outcomes in adult patients admitted for trauma in the United States' trauma centers.

Data were extracted from the National Trauma Data Bank (NTDB). There were 5301 patients who had PsyPECs, out of 2 636 037 patients in NTDB that met inclusion criteria. The PsyPECs studied were schizophrenia, bipolar disorder, major depressive disorder (MDD), and anxiety disorders, including generalized anxiety, panic, specific phobias, and other unspecified anxiety disorders. Regression analyses were conducted, adjusting for age, sex, and status on diabetes mellitus and obesity.

Falls as the mechanism of injury were more likely to occur among patients with an anxiety disorder, MDD, or bipolar disorder. Patients with schizophrenia, bipolar disorder, or MDD had higher odds of stabbing injuries (cut/pierce). However, patients with an anxiety disorder had decreased odds of stabbing injuries. Patients with schizophrenia or bipolar disorder were more likely to be hit by a car compared to patients without PsyPECs. Patients with an anxiety disorder had higher odds of intensive care unit readmission. A longer H-LOS was associated with patients with schizophrenia (1.30 days), bipolar disorder (2.15 days), MDD (0.58 days), or anxiety disorder (0.76 days) compared to patients without those PsyPECs.

Pre-existing psychiatric conditions impact traumatic injury mechanisms, injury type, and outcomes. This study indicates the need for further research on this population. Incorporating mental health into trauma care plans may improve outcomes. Understanding the role that psychiatric illnesses may play in injury and recovery is essential for delivering high quality, effective trauma care.