32 Major Psychiatric Illness and Drug Dependence Both Influence Burn Outcomes, but Not in the Same Way

Abstract

Abstract Introduction Studies of trauma patients indicated that as many as 17% of patients have major mental illness. The prevalence of mental illness in burns is not well known, but is thought to be similar to that seen in trauma. In this study we aim to examine the effect of mental health on outcomes following burns less than 20% total body surface area (%TBSA). We hypothesize that mental illness is associated with longer length of stay (LOS), length of stay per % TBSA (LOS/TBSA), and number of readmissions. Methods Following IRB approval, a 2-year (2016–2018) retrospective chart review was conducted of burn patients with burns less than 20% admitted to the burn center. Data collected include: age, sex, % TBSA, LOS, LOS/TBSA, discharge disposition, mortality, presence of mental health diagnoses (Drug Dependence, and Major Psychiatric Illness). Statistical analysis with chi-square for categorical variables and student’s t-test for continuous variables was conducted. Values expressed as mean ± standard deviation. Results A total of 961 patients with a mean age of 46.2±17.4 years, 717 men and 244 women, were analyzed. Mean total body surface area burn (TBSA) was 6.72±5.5%, and 6.14% had inhalation injury. In this study population 27.6% had drug dependence, and 15.4% had major psychiatric illness. The mean length of stay was 11.4±16.7 days, and 12 patients (1.25%) died. In examining the effects of major psychiatric illness, there was no difference in age (46.4 vs. 46.2 years, p=0.87), no difference in %TBSA (6.30% vs. 6.77%, p=0.328). Length of stay (LOS) (15.2 vs. 10.7 days, p=0.0009) and LOS/TBSA (4.03 vs. 2.90 days, p = 0.03) were increased in patients with major psychiatric illness. There was no difference in the rate of readmissions (8.11% vs. 6.56%, p=0.49). In examining the effects of drug dependence, patients were younger (40.4 vs. 48.4 years, p< 0.0001), suffered a larger %TBSA (7.70% vs. 6.31%, p=0.0008), and had a longer length of stay (13.7 vs. 10.5 days, p=0.04). There were no differences in LOS/TBSA (2.94 vs. 3.12 days, p = 0.66), and rate of readmissions (6.04% vs. 7.09%, p=0.56). Conclusions In burns < 20% TBSA, both major psychiatric illness and drug dependence influence patient’s outcomes. Major psychiatric illness does not affect burn size but does increase length of stay. Drug dependence leads to larger burn size which secondarily increases length of stay. Based on these increases in length of stay, it is likely that hospital costs are also higher for these patients. Further work must be done to mitigate the effects of mental illness on burn outcomes, even in small burns. Applicability of Research to Practice Many burn patients have mental health problems. These can influence their recovery from burn injury. We should work to minimize the effects of their mental illness on their outcomes.