Head Trauma Mechanisms and Neuroimaging Findings in Psychiatric Inpatients Referred for Neurosurgical Consultation

Background: Psychiatric inpatients may be vulnerable to head trauma; however, associations among psychiatric diagnosis, trauma mechanisms, and acute trauma-related neuroimaging findings among patients requiring neurosurgical consultation remain unclear. Methods: This retrospective observational study included psychiatric inpatients referred for neurosurgical consultation after head trauma at a tertiary neuropsychiatric specialty hospital between July 2022 and December 2025. Psychiatric diagnoses were grouped into psychotic, mood, substance use, organic/symptomatic, and other disorders. Trauma mechanisms were classified as falls, self-harm, assault/fight-related injuries, and other trauma types. Radiological findings were classified as trauma-related abnormalities or secondary incidental findings, including age-related changes. Associations were evaluated using chi-square tests, with false discovery rate correction applied to global and binary comparisons. Exploratory multivariable regression models were used as sensitivity analyses. Results: The cohort comprised 461 psychiatric inpatients who sustained head trauma, underwent radiological imaging, and were referred for neurosurgical consultation. Trauma mechanisms differed significantly across psychiatric diagnostic groups (χ² = 30.89, p = 0.002). Falls were the most common mechanism (189/461, 41.0%). Assault/fight-related trauma showed the clearest diagnosis-associated pattern (χ² = 19.72, p < 0.001, Cramér's V = 0.207) and remained the only significant binary outcome after false discovery rate correction. Acute trauma-related imaging findings were observed in 35 patients (7.6%) and were not associated with psychiatric diagnosis (χ² = 6.16, p = 0.187). Calcifications were the most frequent imaging finding (191/461, 41.4%). Conclusions: In psychiatric inpatients, while head trauma patterns and neuroimaging findings have the potential to be explained by psychiatric diagnoses, they may also reflect unmeasured behavioral and clinical factors.