title: Risk factors for medical deterioration of psychiatric inpatients: opportunities for early recognition and prevention.
abstract: BACKGROUND
  Medical deterioration during admission to free-standing psychiatric hospitals is distressing for patients, interrupts bio-behavioral interventions, and places a substantial burden on health care resources. Emergency transfers to a general hospital are a reasonable marker of significant medical deterioration, but have not been assessed systematically.
  
  
  OBJECTIVE
  To use clinical data available at the time of psychiatric admission to identify risk factors for transfers to a general hospital.
  
  
  METHODS
  Retrospective review of the hospital course of 1000 adults consecutively admitted for an average of 19.1 ± 21.3 days to a single free-standing psychiatric hospital in 2010.
  
  
  RESULTS
  One hundred forty-four patients (14.4%) were transferred to a general hospital. Transferred and not-transferred groups differed significantly with regard to age, presence of dementia, number of comorbid medical disorder, history of arterial hypertension, blood urea nitrogen (BUN), creatinine, albumin, glucose, calcium, hemoglobin, and hematocrit (P < .001). In a multiple logistic regression analysis, blood urea nitrogen (odds ratio [OR], 63.2), hemoglobin (OR, 35.3), albumin (OR, 7.3) and age (OR, 5.73) were independently associated with transfers. Acute medical deteriorations occurred in 46.2% of patients with azotemia (BUN >24 mg/dL), 32.7% of those with anemia (Hb <12 g/L), 37.5 % of those with hypoalbuminemia (albumin <3.7 g/dL), and 37.4% of patients 65 and older.
  
  
  CONCLUSIONS
  Medical deterioration of psychiatric inpatients correlates with higher BUN, lower albumin and hemoglobin, and older age. Baseline azotemia, anemia or hypoalbuminemia should trigger prompt medical evaluation and enhanced monitoring to prevent, identify, and treat somatic disorders.
authors.affiliation: Zucker Hillside Hospital, North Shore-Long Island Jewish Health System, Glen Oaks, New York 11004, USA. pmanu@nshs.edu
authors.forename: Peter
authors.initials: P
authors.lastname: Manu
authors.forename: Muhammad
authors.initials: M
authors.lastname: Asif
authors.forename: Sameer
authors.initials: S
authors.lastname: Khan
authors.forename: Husnein
authors.initials: H
authors.lastname: Ashraf
authors.forename: Anup
authors.initials: A
authors.lastname: Mani
authors.forename: Perihan
authors.initials: P
authors.lastname: Guvenek-Cokol
authors.forename: Hanna
authors.initials: H
authors.lastname: Lee
authors.forename: John M
authors.initials: JM
authors.lastname: Kane
authors.forename: Christoph U
authors.initials: CU
authors.lastname: Correll
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D006259:Craniocerebral Trauma / Q000175:diagnosis; D042241:Early Diagnosis; D005260:Female; D005334:Fever / Q000175:diagnosis; D006760:Hospitalization; D006801:Humans; D007297:Inpatients; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D010146:Pain / Q000175:diagnosis; D010360:Patient Transfer; D012189:Retrospective Studies; D012307:Risk Factors; D012640:Seizures / Q000175:diagnosis; D012737:Sex Factors