A Study of the Impact of Psychiatric Illness and/or Intoxication on Orthopaedic Morbidity in St. James’s Hospital Dublin, July 2011

Objective: To assess the impact of psychiatric illness and/or intoxication on injury severity and the duration and complexity of hospital stay in orthopaedic patients. Material and Methods: All orthopaedic admissions for July 2011 to the Emergency Department at St. James’s Hospital were reviewed. Patients were categorised into four groups. Group 1 (n=65): control group. No psychiatric illness, sober on admission. Group 2 (n=15): patients with psychiatric co-morbidity. Group 3 (n=8): patients whose psychiatric co-morbidity directly caused injury. Group 4 (n=15): patients whose intoxication (alcohol and/or drug) caused the injury which was the reason for admission. Results: Comparison of Groups 1 and 2 revealed the following: Group 2 had x3 greater mean duration of stay (5.95, 20.1); x2 the mean number of theatre procedures (0.64, 1.27); > x2 the mean number of investigations (e.g. x-ray, CT and MRI) (1.0, 2.36). These results were overshadowed by comparison of Groups 1 and 3. Group 3 had x6 higher mean duration of hospital stay (5.95, 34.88); x3 the number of theatre procedures (0.64, 2.13); x3.5 the mean number of investigations (1.0, 3.5). Intoxication (Group 4) caused x3 increase in hospital stay (5.95, 17.43); 25% increase in average number of investigations (1.0, 1.23); x3 increase in non-psychiatric consultations (0.214, 0.875). Mean injury severity scores were highest in Group 3 (7.88); then Group 2 (6.87) and then Group 1 (5.34), revealing worse injuries associated with psychiatric illness. Conclusion: Psychiatric illness and substance abuse were associated with substantially greater orthopaedic morbidity and duration and complexity of hospital stay. (JAEM 2013; 12: 57-60)