The effect of psychiatric comorbidities on in-hospital outcomes and mortality following isolated traumatic brain injury: a retrospective cohort analysis study.

PURPOSE: The impact of preexisting psychiatric illness on outcomes following traumatic brain injury (TBI), particularly mortality and in-hospital complications, remains poorly understood. This study aimed to evaluate the influence of psychiatric comorbidities on the clinical outcomes of patients with isolated blunt TBI.

METHODS

We conducted a retrospective analysis using data from the American College of Surgeons Trauma Quality Programs database (2014-2016). Patients aged 18 years or older with isolated blunt TBI were included. Participants were categorized based on the presence or absence of a psychiatric comorbidity. Outcomes assessed included in-hospital complications, length of stay, intensive care unit (ICU) admission, and mortality. Variables with P<0.05 in univariate analysis were entered into logistic regression models to determine the independent effect of psychiatric comorbidity on adverse outcomes.

RESULTS

Of 32,304 patients, 2,580 (8.0%) had psychiatric comorbidities. These patients were significantly older and exhibited higher rates of other comorbid conditions and substance abuse. Univariate analysis demonstrated significantly worse outcomes among patients with psychiatric illness, including higher mortality (8.6% vs. 5.0%), greater ICU admission rates (33.4% vs. 24.0%), and increased rates of sepsis (0.9% vs. 0.3%), pneumonia (2.5% vs. 1.2%), and pulmonary embolism (0.4% vs. 0.1%). Logistic regression confirmed psychiatric comorbidity as an independent predictor of mortality (adjusted odds ratio [aOR], 1.98; 95% confidence interval [CI], 1.70-2.31), sepsis (aOR, 2.36; 95% CI, 1.45-3.84), pneumonia (aOR, 1.70; 95% CI, 1.25-2.25), pulmonary embolism (aOR, 2.50; 95% CI, 1.21-5.15), and acute respiratory distress syndrome (aOR, 3.09; 95% CI, 1.93-4.94), after controlling for comorbidities and demographic factors.

CONCLUSIONS

Psychiatric comorbidity is associated with significantly higher mortality and increased in-hospital complications in patients with isolated blunt TBI. These findings underscore the importance of targeted interventions and management strategies to improve outcomes in this vulnerable patient population.