The Trauma Center as an Opportunity for Screening, Intervention and Injury Prevention
Project Director/Lead Investigator: Rochelle Dicker, MD,Co-Investigators: Jennifer Alvidrez, PhD, Alicia Boccellari, PhD, Dahianna Lopez, RN
Brief Summary of Project:
The specific hypothesis behind this research is that systematic screening for psychiatric disorders in trauma patients is feasible and will assist in identifying individuals who are at high-risk for unintentional injury.
Specific Aims:
1. To carry out systematic psychiatric screening on
acutely injured patients admitted to a trauma center.
2. To measure the prevalence of psychiatric disorders in the
acutely injured trauma center population.
3. To prospectively identify the risk of unintentional injury
recidivism associated with psychiatric disorders in the acutely
injured trauma center population.
4. To perform a needs assessment for the target population
including, but not limited to mental health treatment, for the
purpose of identifying an intervention targeted at preventing
injury recidivism.
5. To complete baseline surveillance in preparation for a future
study which will aim to implement and evaluate the identified
intervention.
Background and Significance/Preliminary Studies:
Psychiatric disorders are a known risk factor for
intentional injuries such as suicide and assault, but the
association between these disorders and unintentional injuries has
not been well studied. Injury prevention among these patients is
particularly important because, as a group, they consume greater
resources after injury and are at high risk for failure to return
to independent living and for the development of PTSD. In a prior
study from our group (funded in the last cycle of our Injury
grant), we examined the records of 1,709 patients admitted to our
hospital and found that 20% carried a pre-existing diagnosis of a
psychiatric disorder. When compared to patients without psychiatric
disorders, individuals with a psychiatric disorder had twice the
rate of unintentional injury requiring hospitalization and 4.5
times the odds of injury recidivism. Those with a psychiatric
disorder were less likely to return to independent living and were
more likely to have sustained their injuries as the result of a
fall or a pedestrian crash rather than a motor vehicle crash.
Identification of patients with psychiatric disorders during their
acute hospitalization for injury presents an opportunity to
intervene in this cycle and could decrease the overall injury rate
in this high-risk population.
Methods:
Patients admitted to the San Francisco General Hospital
following unintentional injury will undergo a structured
neuropsychiatric interview by personnel trained by the faculty from
the Department of Psychiatry in order to screen for psychiatric
disorders. A needs assessment questionnaire will also be utilized
in this interview. It is hoped that this interview process will
lead to a more complete description of this population and identify
methods that might be used to offer some means of intervention,
either in-hospital or post-discharge. Follow-up data via phone
contact with the patient will elicit information on subsequent
mental health treatment and/or recurrent injury. In addition to
establishing true rates of unintentional injury and injury
recidivism in this population, this preliminary study will assist
us in designing an intervention for these high-risk patients.