ABSTRACT
To assess the impact of psychiatric illness and/or intoxication on injury severity and the duration and complexity of hospital stay in orthopaedic patients.
All orthopaedic admissions for July 2011 to the Emergency Department at St. James’s Hospital were reviewed. Patients were categorised into four groups. Group 1 (n=65): control group. No psychiatric illness, sober on admission. Group 2 (n=15): patients with psychiatric co-morbidity. Group 3 (n=8): patients whose psychiatric co-morbidity directly caused injury. Group 4 (n=15): patients whose intoxication (alcohol and/or drug) caused the injury which was the reason for admission.
Comparison of Groups 1 and 2 revealed the following: Group 2 had x3 greater mean duration of stay (5.95, 20.1); x2 the mean number of theatre procedures (0.64, 1.27); > x2 the mean number of investigations (e.g. x-ray, CT and MRI) (1.0, 2.36). These results were overshadowed by comparison of Groups 1 and 3. Group 3 had x6 higher mean duration of hospital stay (5.95, 34.88); x3 the number of theatre procedures (0.64, 2.13); x3.5 the mean number of investigations (1.0, 3.5). Intoxication (Group 4) caused x3 increase in hospital stay (5.95, 17.43); 25% increase in average number of investigations (1.0, 1.23); x3 increase in non-psychiatric consultations (0.214, 0.875). Mean ınjury severity scores were highest in Group 3 (7.88); then Group 2 (6.87) and then Group 1 (5.34), revealing worse injuries associated with psychiatric illness.
Psychiatric illness and substance abuse were associated with substantially greater orthopaedic morbidity and duration and complexity of hospital stay.
Keywords: Orthopaedic injury, psychiatric illness, intoxication, injury severity