Preexisting Comorbid Psychiatric Conditions and Mortality in Nonsurgical Intensive Care Patients

Abrams, Thad E.; Vaughan-Sarrazin, Mary; Rosenthal, Gary E.

doi:10.4037/ajcc2010967

Cited by 27 publications

(25 citation statements)

References 27 publications

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“…As demonstrated by Abrams et al, the method utilized to identify mental illness can have a significant impact on observed results. 14, 15, 25 Using outpatient records resulted in a significant association between SMI and 30-day mortality in Veteran’s Health Administration hospital patients, while using inpatient records did not. However, it is also important to note that many previous studies examining outcomes of patients with SMI were conducted in different study populations.…”

Section: Discussionmentioning

confidence: 99%

“…Our findings are consistent with those of Abrams et al who observed that comorbid psychiatric conditions identified using hospital inpatient records were not associated with 30-day mortality in Veteran’s Health Administration hospital patients admitted for acute myocardial infarction or nonsurgical intensive care. 14, 15 Furthermore, Blecker et al (2010) observed no association between SMI and quality of care, including hospital readmission, in disabled Medicaid recipients with heart failure. 16 …”

Section: Discussionmentioning

confidence: 99%

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Serious Mental Illness and Acute Hospital Readmission in Diabetic Patients

et al. 2012

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Patients with serious mental illness (SMI), particularly those with other chronic illnesses, may be vulnerable to unplanned hospital readmission. We hypothesized that SMI would be associated with increased 30-day hospital readmission in a cohort of adult patients with comorbid diabetes admitted to a tertiary-care facility from 2005–2009. SMI was defined by ICD-9 discharge diagnosis codes for schizophrenia, schizo-affective, bipolar, manic, or major depressive disorders, or other psychosis. The primary outcome was 30-day readmission to the index hospital. Among 26,878 eligible admissions, prevalence of SMI was 6% and incidence of 30-day hospital admission was 16%. Among patients aged <35 years, SMI was significantly associated with decreased odds of 30-day hospital readmission (OR 0.39, 95% CI: 0.17, 0.91). However, among patients ≥35 years, SMI was not significantly associated with 30-day hospital readmission (OR 1.11, 95%CI: 0.86, 1.42). SMI may not be associated with increased odds of 30-day hospital readmission in this population.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Serious Mental Illness and Acute Hospital Readmission in Diabetic Patients

et al. 2012

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“…Previous researchers speculate that effects of psychiatric comorbidity on doctor-patient communication might play a role [14], and psychological or social factors associated with PTSD as either risk factors or symptoms might influence how timely and successfully a patient responds to symptoms of illness, influencing their clinical course [47,52,53].…”

Section: Discussionmentioning

confidence: 99%

“…Costs of patients with PTSD exceed the costs of patients without PTSD by between 8% and 75% when PTSD occurred as a result of traffic accidents [11,12], and there is some evidence that poor psychological health and psychological disorders, such as PTSD, complicate clinical course even in routine surgical procedures [13]. Yet there are dissenting findings how PTSD affects the clinical course [14]. In a study assessing patients admitted to a Level I Trauma Centre, post-traumatic stress syndrome (PTSS) following traumatic injury was associated with an average length of stay (LOS) increase of 2 days [15], as poor psychological health in general was associated with an increased LOS in several studies [16,17].…”

Section: Introductionmentioning

confidence: 99%

Hospital costs associated with post-traumatic stress disorder in somatic patients: a retrospective study

et al. 2020

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Background: Post-traumatic stress disorder is likely to affect clinical courses in the somatic hospital ward when appearing as comorbidity. Thus, this study aimed to assess the costs associated with comorbid post-traumatic stress disorder in a somatic hospital and to analyze if reimbursement appropriately compensated additional costs. Methods: The study used data from a German university hospital between 2011 and 2014, analyzing 198,819 inpatient episodes. Inpatient's episodes were included for analysis if they had a somatic primary diagnosis and a secondary diagnosis of post-traumatic stress disorder. Costs were calculated based on resource use and compared to reimbursement. Analyses were adjusted for sex, age and somatic comorbidities. Results: N = 219 Inpatient's episode were found with primary somatic disorder and a comorbid post-traumatic stress disorder. Inpatients episodes with comorbid post-traumatic stress disorder were compared to 34,229 control episodes, which were hospitalized with the same main diagnosis. Post-traumatic stress disorder was associated with additional hospital costs of €2311 [95%CI €1268-€3355], while reimbursement rose by €1387 [€563-€2212]. Results indicate that extra costs associated with post-traumatic stress disorder are not fully reimbursed. Male patients showed higher hospital costs associated with post-traumatic stress disorder. On average, post-traumatic stress disorder was associated with an extra length of stay of 3.4 days [2.1-4.6 days]. Conclusion: Costs associated with post-traumatic stress disorder were substantial and exceeded reimbursement, indicating an inadequate reimbursement for somatic patients with comorbid post-traumatic stress disorder.

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“…24 Two papers describe case vignettes of patients who had exacerbations of their PTSD while in the Intensive Care Unit (ICU), although neither contain frequency or severity data. 25,26 Approximately 8% of patients in VA ICUs have PTSD, 27 and a published abstract suggests that they appear to require more sedation than do patients without PTSD. 28 Another published case report describes a patient with recurrent PTSD symptoms (nightmares) after moving into a nursing home.…”

Section: The Literature About Ptsd In Hospitalized Patientsmentioning

confidence: 99%

Hospitalized Medical Patients with Posttraumatic Stress Disorder (PTSD): Review of the Literature and a Roadmap for Improved Care

et al. 2020

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Posttraumatic Stress Disorder (PTSD) is common in the United States, with a prevalence of nearly 8% in the general population and between 10%-30% in veterans. Despite how common PTSD is, inpatient providers may not be familiar with its manifestations or feel comfortable taking care of patients who may exhibit symptoms related to it. In our combined experience as VA-based hospital medicine care providers, we have cared for thousands of patients hospitalized for a primary medical condition who also have PTSD as a comorbidity. We have noticed in our practices that we only focus our attention on PTSD if a related problem arises during a patient’s hospitalization (eg, confrontations with the care team or high levels of anxiety). We contend that a more proactive approach could lead to better care, but little evidence about best practices exists to inform the interdisciplinary team how to optimally care for hospitalized medical patients with PTSD. In this narrative review, we present a synthesis of existing literature, describe how trauma-informed care could be used to guide the approach to patients with PTSD, and generate ideas for changes that inpatient providers could implement now, such as engaging patients to prevent PTSD exacerbations and promoting better sleep in the hospital.

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Preexisting Comorbid Psychiatric Conditions and Mortality in Nonsurgical Intensive Care Patients

Cited by 27 publications

References 27 publications

Serious Mental Illness and Acute Hospital Readmission in Diabetic Patients

Serious Mental Illness and Acute Hospital Readmission in Diabetic Patients

Hospital costs associated with post-traumatic stress disorder in somatic patients: a retrospective study

Hospitalized Medical Patients with Posttraumatic Stress Disorder (PTSD): Review of the Literature and a Roadmap for Improved Care

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