title: Psychiatric Illness Is Common Among Patients with Orthopaedic Polytrauma and Is Linked with Poor Outcomes.
abstract: BACKGROUND
  Psychiatric disorders are common, and their functional consequences may be underappreciated by non-mental health-care providers. There exist limited data regarding the frequency of psychiatric illness in patients who sustain orthopaedic polytrauma. The purpose of this study was to describe the prevalence of psychiatric illness in patients with orthopaedic polytrauma, to determine whether psychiatric illnesses were identified and were accommodated by trauma providers, and, finally, to investigate any associations between postoperative complications and psychiatric illness.
  
  
  METHODS
  Three hundred and thirty-two skeletally mature patients with surgically treated axial and/or femoral fractures and injuries to other body systems (Injury Severity Score of ≥ 16 points) were identified from a database at a Level-I trauma center. These included 238 men and ninety-four women with a mean value (and standard deviation) of 39 ± 16 years for age and 27 ± 12 points for the Injury Severity Score. Records were reviewed for preexisting diagnoses of psychiatric disorders. The inpatient courses and discharge recommendations regarding treatment of psychiatric illness were analyzed. Complications in the six-month postoperative period were determined by an independent committee.
  
  
  RESULTS
  Preexisting psychiatric disorders were identified in 130 patients (39.2%), including depression in seventy-four patients (22.3%) and substance abuse in fifty-six patients (16.9%). Patients managed by an orthopaedic surgery service were less likely to receive their home psychiatric medications while hospitalized (p = 0.001) and were less likely to receive instructions for psychiatric follow-up at discharge (p = 0.087). Postoperative complications occurred in sixty-six patients (19.9%) overall; depression was an independent predictor of increased complications, with an odds ratio of 2.956 (95% confidence interval, 1.502 to 5.816).
  
  
  CONCLUSIONS
  Psychiatric illness was common among individuals who sustained orthopaedic polytrauma, and patients with depression had more complications. This study highlights the need for greater attention to mental health disorders in this population.
authors.affiliation: Department of Orthopaedic Surgery, University Hospitals, Case Medical Center, Case Western Reserve University, Cleveland, Ohio Dsw56@case.edu.
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Weinberg
authors.affiliation: School of Medicine, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Arvind S
authors.initials: AS
authors.lastname: Narayanan
authors.affiliation: School of Medicine, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Kaeleen A
authors.initials: KA
authors.lastname: Boden
authors.affiliation: Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Mary A
authors.initials: MA
authors.lastname: Breslin
authors.affiliation: Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Heather A
authors.initials: HA
authors.lastname: Vallier
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005264:Femoral Fractures / Q000150:complications / Q000601:surgery; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000150:complications* / Q000601:surgery; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications* / Q000601:surgery; D019637:Orthopedic Procedures; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000453:epidemiology / Q000523:psychology; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors