Impact of Psychiatric Illness on Clinical Outcomes of Patients With Multiple Rib Fractures: Insights From a National Trauma Database

Abstract

Objective

The objective of this study was to compare in-hospital outcomes and mortality in patients with and without a psychiatric comorbidity that presented to a trauma center with isolated blunt chest trauma and multiple traumatic rib fractures.

Materials and Methods

This is retrospective analysis using the American College of Surgeons Trauma Quality Improvement Program database (2014-2016). Patients ≥18 years with ≥3 traumatic rib fractures were stratified based on the presence or absence of a psychiatric comorbidity. In-hospital complications, length of stay, intensive care unit (ICU) admission, and mortality were assessed. Variables significant (P < 0.05) on univariate analysis were entered into logistic regression models to determine the independent effect of a psychiatric comorbidity on outcomes.

Results

Among the 56,558 patients meeting inclusion criteria, 10.6% (n = 6022) had a psychiatric comorbidity. On univariate analysis, patients with a psychiatric comorbidity demonstrated significantly worse in-hospital outcomes, including higher rates of acute respiratory distress syndrome (ARDS) (1.0% vs 0.7%), deep vein thrombosis (DVT) (1.5% vs 1.2%), pulmonary embolism (PE) (0.8% vs 0.5%), pneumonia (4.2% vs 3.1%), urinary tract infection (2.4% vs 1.7%), and decreased mortality (2.2% vs 3.5%). After controlling for comorbidities, substance use, and demographic factors, psychiatric comorbidity was an independent predictor of ARDS (aOR 1.15, P < 0.01), DVT (OR 1.32, P = 0.017), PE (aOR 1.40, P = 0.004), pneumonia (aOR 1.36, P < 0.001), and decreased mortality (aOR 0.71, P < 0.001).

Conclusions

The presence of a psychiatric comorbidity increases in-hospital complications independent of patient characteristics, comorbidities, and trauma burden in patients presenting with multiple traumatic rib fractures.