Presence and Dose-Response Effect of Psychiatric Comorbidity on Hospital Outcomes in Traumatic Spinal Fracture Patients
Neema Darabi, Varshal Patel, Alexa R. Lauinger, Alexis Watson, Wedam Nyaaba, Gregory M. Polites, Paul M. ArnoldStudy Design:
Retrospective cohort study.
Objective:
To evaluate the association between psychiatric comorbidity and in-hospital outcomes in traumatic spinal fracture patients, as well as the dose-response relationship between psychiatric burden and outcomes.
Summary of Background Data:
Psychiatric comorbidities are prevalent among trauma patients and associated with worse acute outcomes, yet few studies have examined this relationship in spinal fracture patients specifically, and none have assessed the cumulative effect of multiple psychiatric conditions.
Methods:
Traumatic spinal fracture patients were identified from the 2018 to 2023 National Trauma Data Bank using ICD-10 codes. Psychiatric comorbidity was characterized as a binary indicator and a Psychiatric Burden score reflecting the number of distinct diagnostic categories. Propensity score matching (1:2) was performed to compare patients with and without psychiatric comorbidity on length of stay (LOS), ventilator use, ventilator duration, mortality, and severe sepsis. Dose-response analyses were conducted in the psychiatric subgroup using multivariate regression with Psychiatric Burden as a continuous predictor.
Results:
Of 940,733 analytic patients, 4731 (0.50%) had ≥1 psychiatric comorbidity. After matching, psychiatric comorbidity was associated with 22.8% longer LOS (95% CI: 19.2–26.5%,
Conclusion:
Psychiatric comorbidity is an independent and dose-dependent predictor of prolonged hospitalization in traumatic spinal fracture patients, with higher psychiatric burden associated with less invasive respiratory management. A count of psychiatric diagnoses at admission may serve as a low-cost criterion for prioritizing early behavioral health involvement. Prospective evaluation is needed to determine whether such an intervention alters in-hospital outcomes.
Levels of Evidence
Level III.