The association of psychiatric and neurological comorbidities with outcomes in traumatic injury patients

2021 ◽  
pp. 009121742198914
Author(s):  
Jennifer Brady ◽  
R David Hayward ◽  
Elango Edhayan
Keyword(s):  
Length Of Stay ◽  
Psychiatric Illness ◽  
Traumatic Injury ◽  
Lower Mortality ◽  
Linear Modeling ◽  
Psychiatric Comorbidities ◽  
Trauma Outcomes ◽  
Hospital Stays ◽  
The Impact ◽  
The Relationship

Introduction Mental illness is a well-known risk factor for injury and injury recidivism. The impact of pre-existing psychiatric illness on trauma outcomes, however, has received less attention. Our study examines the relationship of pre-existing psychiatric illness on trauma outcomes including length of stay, cost, and mortality. Methods Patient data were obtained from the Healthcare Cost and Utilization Project’s State Inpatient Database. All patients admitted for trauma in the Detroit metropolitan area from 1/1/2006 to 12/31/2014 were included. The relationship between individual psychiatric comorbidities (depression, psychosis, and other neurological disorders) and outcomes were evaluated with logistic regression (mortality) and generalized linear modeling (length of stay and cost). Results Over 260,000 records were reviewed. Approximately one-third (29.9%) of patients had one or more psychiatric diagnoses. Patients with depression had longer hospital stays (RR = 1.12, p < 0.001) and higher costs (RR = 1.07, p < 0.001), but also lower mortality (OR = 0.69, p < 0.001). Patients with psychosis had longer stays (RR = 1.18, p < 0.001), higher costs (RR = 1.02, p = 0.002), and lower mortality (OR = 0.61, p < 0.001). Patients with other neurological comorbidities had higher mortality (OR = 1.23, p < 0.001), longer stays (RR = 1.29, p < 0.001), and higher costs (RR = 1.10, p < 0.001). Conclusion Patients with a psychiatric disorder required longer care and incurred greater costs, whereas mortality was higher for only those with a neurological disorder. Identifying patients’ psychiatric comorbidities at the time of admission for trauma may help optimize treatment. Addressing these conditions may help reduce the cost of trauma care.

The Impact of Anticoagulation on Trauma Outcomes

2020 ◽  
Vol 86 (7) ◽  
pp. 773-781
Author(s):  
Rosalynn K. Nguyen ◽  
James H. Rizor ◽  
Michael P. Damiani ◽  
Andrew J. Powers ◽  
Jacob T. Fagnani ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Injury Severity ◽  
Traumatic Injury ◽  
Anticoagulation Therapy ◽  
Care Facility ◽  
Data Bank ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Trauma Outcomes ◽  
The Impact

Background Increased prevalence of patients on anticoagulants and the advent of new therapies raise concern over how these patients fare if they sustain a traumatic injury. We investigated the role of prehospitalization anticoagulation therapy in trauma-related mortality and postacute disposition. Methods A retrospective analysis was performed on patients who sustained traumatic injury identified in the 2017 National Trauma Data Bank (NTDB). Patients with and without anticoagulation therapy were analyzed to identify differences in demographics, injury type, Injury Severity Score (ISS), and trauma outcomes including hospital length of stay, ER, final hospital disposition, and mortality. Logistic regression was used to correlate anticoagulation to mortality and facility discharge. Results Of the 1 000 596 patients included, 73 602 (7%) patients were on anticoagulants at the time of their trauma. Increased age was the strongest predictor for anticoagulation therapy (odds ratio 5.54, 95% CI 5.44-5.63), but being female and white were also independent predictors of anticoagulation ( P < .001). Patients on anticoagulants had a significantly longer length of stay (5.11 days; 95% CI 5.06-5.15) than those who were not (4.37 days, 95% CI 4.36-4.39), were 2.20 times more likely to die (95% CI 2.12-2.28, P < .001), and were 2.77 times more likely to be discharged to a facility (95% CI 2.73-2.81, P < .001). Anticoagulation remained a significant predictor of worse trauma outcomes even when accounting for age and ISS in multivariate analysis. Discussion Anticoagulation preceding trauma-related admission is associated with higher mortality and an increased likelihood of the need for a posthospital care facility.

An Objective Study of the Impact of the Electronic Medical Record on Outcomes in Trauma Patients

2012 ◽  
Vol 78 (11) ◽  
pp. 1249-1254 ◽  
Author(s):  
Paul J. Schenarts ◽  
Claudia E. Goettler ◽  
Michael A. White ◽  
Brett H. Waibel
Keyword(s):  
Length Of Stay ◽  
Medical Record ◽  
Electronic Medical Record ◽  
Injury Severity ◽  
Unit Length ◽  
Traumatic Injury ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Delay In Diagnosis ◽  
The Impact

It is commonly believed that the electronic medical record (EMR) will improve patient outcomes. However, there is scant published literature to support this claim and no studies in any surgical population. Our hypothesis was that the EMR would not improve objective outcome measures in patients with traumatic injury. Prospectively collected data from our university-based Level I trauma center was retrospectively reviewed. Demographic, injury severity as well as outcomes and complications data were compared for all patients admitted over a 20-month period before introduction of the EMR and a 20-month period after full, hospital-wide use of the EMR. Implementation of the EMR was associated with a decreased hospital length of stay, P = 0.02; intensive care unit length of stay, P = 0.001; ventilator days, P = 0.002; acute respiratory distress syndrome, P = 0.006, pneumonia, P = 0.008; myocardial infarction, P = 0.001; line infection, P = 0.03; septicemia, P = 0.000; renal failure, P = 0.000; drug complication, P = 0.001; and delay in diagnosis, P = 0.04. There was no difference in mortality, unexpected cardiac arrest, missed injury, pulmonary embolism/deep vein thrombosis, or late urinary tract infection. This is the first study to investigate the impact of the EMR in surgical patients. Although there was an improvement in some complications, the overall impact was inconsistent.

Life Events and Psychiatric Disorder: the Role of a Natural Disaster

1987 ◽  
Vol 151 (3) ◽  
pp. 362-367 ◽  
Author(s):  
Alexander C. McFarlane
Keyword(s):  
Psychiatric Disorder ◽  
Life Events ◽  
Psychological Health ◽  
Psychiatric Illness ◽  
General Health Questionnaire ◽  
Health Questionnaire ◽  
Fire Fighters ◽  
The Impact ◽  
The Relationship

Examining the impact of natural disasters on psychological health provides an opportunity to study the role played by extreme adversity in the onset of psychiatric disorder. Four hundred and sixty-nine fire-fighters who had been intensely exposed to an Australian bushfire disaster completed a detailed inventory of their experiences four months later. They also completed a brief life events schedule and the 12-item General Health Questionnaire. Only 9% of the GHQ score variance could be accounted for by the disaster and other life events; the effects of the disaster appeared to be separate and additive. This is similar to the relationship between life events and psychiatric illness found in other settings. It is suggested that vulnerability is a more important factor in breakdown than the degree of stress experienced.

scholarly journals Sleep disorders in children and adolescents†

2015 ◽  
Vol 21 (2) ◽  
pp. 124-131 ◽  
Author(s):  
Gregory Stores
Keyword(s):  
Children And Adolescents ◽  
Sleep Disorders ◽  
Psychiatric Illness ◽  
Risk Groups ◽  
Sleep Medicine ◽  
Child And Adolescent Psychiatry ◽  
Accurate Diagnosis ◽  
Contributory Factor ◽  
The Impact ◽  
The Relationship

SummaryDisordered sleep has long been recognised as both a consequence of psychiatric illness and a contributory factor to its development. Significant sleep disturbance occurs in about 25% of children and adolescents and 80% or more of children in high-risk groups; it often continues into adulthood. All psychiatrists should therefore be familiar with the principles of sleep medicine and the impact of sleep and its disorders. In this article, the relationship between sleep disorders and the breadth of child and adolescent psychiatry in particular is explored. The classification, aetiology and implications of sleep disorders are discussed, as well as the practicalities of screening, diagnosis and management, with a view to informing readers how accurate diagnosis, prevention and successful treatment of sleep disorders can benefit patients and their families.

scholarly journals Nurses' Perceptions of Nurse Staffing and the Impact on Patient Falls

2014 ◽  
Author(s):  
Kristin Henry
Keyword(s):  
Critical Role ◽  
Nurse Staffing ◽  
Advanced Practice ◽  
Patient Falls ◽  
Ideal Position ◽  
Number Of Patients ◽  
Hospital Stays ◽  
Nurses Perceptions ◽  
The Impact ◽  
The Relationship

<p>Patient falls contribute to unnecessary injury and incapacitation for patients and are also a major source of stress for the nurses caring for patients who fall. Hospitals are no longer being reimbursed for extended hospital stays related to injuries caused by patient falls and action is needed to decrease such events. Nurse staffing has been shown to play a critical role in determining the incidence of patient falls, with better nurse staffing decreasing the likelihood of a patient falling. The purpose of this study was to determine nurses’ perceptions of nurse staffing and its impact on the incidence of patient falls. The methodology included a short, self-administered survey developed by the researcher. Nurses answered 15 questions related to the number of patients they cared for, number of patient falls, and factors that could influence falls. Nurses who completed the survey reported caring for between 2-7 patients on their last shift and reported between 0-2 falls on their assignment within the previous three months. Nurses indicated that factors such as admission and discharge activity, the number of available staff on the unit, and the acuity of patients on the unit impacted patient falls. Further research is needed to determine the relationship between nurse staffing and the incidence of patient falls. Advanced Practice Registered Nurses (APRNs) are in an ideal position to participate in research related to this topic as well to advocate for nursing’s role in preventing patient falls.</p>

Costs of Vasospasm in Patients With Aneurysmal Subarachnoid Hemorrhage

Neurosurgery ◽  
2010 ◽  
Vol 67 (2) ◽  
pp. 345-352 ◽  
Author(s):  
Chia-Hung Chou ◽  
Shelby D. Reed ◽  
Jennifer S. Allsbrook ◽  
Janet L. Steele ◽  
Kevin A. Schulman ◽  
...  
Keyword(s):  
Subarachnoid Hemorrhage ◽  
Length Of Stay ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Endovascular Coiling ◽  
Billing Data ◽  
Surgical Clipping ◽  
Physician Billing ◽  
Symptomatic Vasospasm ◽  
Hospital Stays ◽  
The Impact

Abstract OBJECTIVE To assess the impact of vasospasm on costs, length of stay, and mortality among inpatients with aneurysmal subarachnoid hemorrhage. METHODS We combined hospital accounting and physician billing data for a consecutive cohort of 198 patients who underwent surgical clipping or endovascular coiling for subarachnoid hemorrhage repair. We considered patients with transcranial Doppler (TCD) velocity of 120 cm/s or greater in the middle cerebral artery to have TCD-defined vasospasm and patients with delayed ischemic neurological deficit to have symptomatic vasospasm. We compared outcomes of patients with TCD-defined vasospasm (n = 116) and those without (n = 73) and patients with symptomatic vasospasm (n = 62) and those without (n = 127), adjusting for demographic and clinical characteristics. RESULTS In adjusted analyses, the incremental cost attributable to TCD-defined vasospasm was 1.20 times higher (95% confidence interval, 1.06–1.36; P = .004) than for patients without TCD-defined vasospasm. Length of stay was an estimated 1.22 times longer for patients with TCD-defined vasospasm (95% CI, 1.07–1.39; P &lt; .01). For symptomatic vasospasm, adjusted costs were 1.27 times higher (95% CI, 1.12–1.43; P &lt; .001) and length of stay was an estimated 1.24 times longer (95% CI, 1.09–1.40; P &lt; .01) for patients with vasospasm than for those without. There was no significant relationship between either type of vasospasm and in-hospital mortality. CONCLUSION Patients with subarachnoid hemorrhage and TCD-defined or symptomatic vasospasm incur higher inpatient costs and longer hospital stays than those without vasospasm.

PP8 Trauma and the obesity epidemic: a systematic review of the impact of obesity on trauma mortality and morbidity

2019 ◽  
Vol 36 (10) ◽  
pp. e5.1-e5
Author(s):  
Simon Mayer ◽  
Sumitra Lahiri ◽  
Joseph Rowles
Keyword(s):  
Systematic Review ◽  
Length Of Stay ◽  
Injury Severity ◽  
Traumatic Injury ◽  
Strong Relationship ◽  
Normal Weight ◽  
The Body ◽  
Trauma Patients ◽  
Mortality And Morbidity ◽  
The Impact

BackgroundTrauma and obesity are both current global epidemics. A simple way to measure the body habitus of patients, to identify the overweight or obese is via the internationally recognized calculation of body mass index (BMI). The primary aim of this systematic review is to assess the mortality rate of those patients with a BMI > 30 kg/m2 in relation to traumatic injury and secondly to assess the effect of those patients with BMI > 30 kg/m2 upon the length of stay in hospital with regards to traumatic injury.MethodA systematic review of the literature was conducted via an internet search of databases and hand searching of references in identified publications from 1st January 1990 to 17th February 2018. Data was extracted from identified publications to include odds ratios of mortality and total length of stay in hospital (days) for patients with a BMI >30 kg/m2 from included studies when compared to patients with a BMI <24.9 kg/m2.ResultsA total of 23 studies met the inclusion criteria. 32, 378 patients were admitted to hospital with a BMI >30 kg/m2 and recorded injury severity score (ISS). Data collated identified BMI >30 kg/m2 OR 1.66 (95% CI 0.75 – 4.2) vs BMI <24.9 kg/m2 OR 0.93 (95% CI 0.82–1.5) to suffer mortality. ISS, BMI >30 kg/m2–19.93 vs 22.3 respectively. Furthermore, those categorised as BMI >30 kg/m2 have 3.78 additional days in the hospital compared to those defined as normal weight.ConclusionThis systematic review presents a strong relationship of increased mortality and complications in trauma patients with BMI >30 kg/m2. Complications are suggestive of those who have a BMI >30 kg/m2 are more likely to suffer detrimental effects following trauma predominantly due to pre-existing unknown co-morbidities. Although, the direct relationship between obesity, trauma and mortality is not fully understood at present and requires more research.

Reducing Surgical Length of Stay: Quantifying the Impact

1995 ◽  
Vol 8 (4) ◽  
pp. 29-35 ◽  
Author(s):  
Brian Louie ◽  
John Guy ◽  
Michael Quinn ◽  
Randy Reid
Keyword(s):  
Health Care ◽  
Caesarean Section ◽  
Length Of Stay ◽  
Medical Records ◽  
Community Hospital ◽  
Hospital Department ◽  
Resource Limited ◽  
Reduction Program ◽  
The Impact ◽  
The Relationship

Length-of-stay (LOS) reduction is a strategy encouraged at all levels of health care to manage within a resource limited environment. However, few organizations have attempted to quantitatively understand the impact of reducing LOS. This study examines the relationship between reducing LOS and cost through a retrospective, medical records analysis of three surgical procedures (appendectomy, cholecystectomy and caesarean section) at an Ontario community hospital Department of Surgery. Hypotheses are presented and a methodology is described. The results are discussed with a focus on the factors that hospitals, adminstrators and physicians might consider in a LOS reduction program.

scholarly journals The impact of blood type on the mortality of patients with severe abdominal trauma: a multicenter observational study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Wataru Takayama ◽  
Akira Endo ◽  
Kiyoshi Murata ◽  
Kota Hoshino ◽  
Shiei Kim ◽  
...  
Keyword(s):  
Observational Study ◽  
Abdominal Trauma ◽  
Blood Type ◽  
Abbreviated Injury Scale ◽  
Trauma Outcomes ◽  
Multicenter Observational Study ◽  
Transfusion Volume ◽  
Type Of Injury ◽  
The Impact ◽  
The Relationship

AbstractFew studies have investigated the relationship between blood type and trauma outcomes according to the type of injury. We conducted a retrospective multicenter observational study in twelve emergency hospitals in Japan. Patients with isolated severe abdominal injury (abbreviated injury scale for the abdomen ≥ 3 and that for other organs < 3) that occurred between 2008 and 2018 were divided into four groups according to blood type. The association between blood type and mortality, ventilator-free days (VFD), and total transfusion volume were evaluated using univariate and multivariate regression models. A total of 920 patients were included, and were divided based on their blood type: O, 288 (31%); A, 345 (38%); B, 186 (20%); and AB, 101 (11%). Patients with type O had a higher in-hospital mortality rate than those of other blood types (22% vs. 13%, p < 0.001). This association was observed in multivariate analysis (adjusted odds ratio [95% confidence interval] = 1.48 [1.25–2.26], p = 0.012). Furthermore, type O was associated with significantly higher cause-specific mortalities, fewer VFD, and larger transfusion volumes. Blood type O was associated with significantly higher mortality and larger transfusion volumes in patients with isolated severe abdominal trauma.

scholarly journals Hospital Outcomes of Adult Diabetic Patients by Glycated Hemoglobin Level in Nonsurgical Pathology in a High-Complexity Institution

2019 ◽  
Vol 12 ◽  
pp. 117955141988267
Author(s):  
German Camilo Giraldo-Gonzalez ◽  
Cristian Giraldo-Guzman ◽  
Abelardo Montenegro-Cantillo ◽  
Angie Carolina Andrade-García ◽  
Duvan Snaider Duran-Ardila ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Length Of Stay ◽  
Glycated Hemoglobin ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Diabetic Patients ◽  
Hospital Stays ◽  
The Relationship ◽  
Hba1c Levels

Recent evidence supports the relationship between in-hospital hyperglycemia and inpatient complications. Besides, glycated hemoglobin (HbA1c) can predict the clinical course of patients with type 2 diabetes mellitus (DM2) during hospital stays. This study aimed to assess the relationship between HbA1c levels and inpatient outcomes. Type 2 diabetes mellitus patients with age greater than 18 years, hospital length of stay greater than 24 hours, and one HbA1c report during their in-hospital management were included. All the electronic care records of patients admitted at the Clinical Versalles, a high-volume institution, in Manizales-Colombia were revised. The following variables were considered: hospital length of stay, diagnoses at the arrival, complications, capillary glucose levels, and treatment at discharge. Variables were categorized by HbA1c levels: group 1 = ⩽ 7%, group 2 = 7.01% to 8.5%, group 3 = 8.51% to ⩽10% and group 4 = >10%. There were a total of 232 patients. Average age was 69.7 years, mean HbA1c was 7.19 ± 2.03, average body mass index (BMI) was 28.8 ± 5.6. About HbA1c, 146 (62.9%) had ⩽7.5%. The most frequent admission diagnosis was by cardiovascular diseases. Average hospitalization was 7.5 ± 5.7 days. There was no relationship between the levels of HbA1c with hospital stays, inpatient complications, or readmissions. Infections and respiratory diseases were more common conditions related to higher HbA1c levels, especially when these were 8.5%. In diabetic patients with nonsurgical diseases and high HbA1c levels, there was no association with clinical complications, length of stay, readmissions, or in-hospital mortality, but changes in treatment at discharge were observed.

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