National estimates of adverse events during nonpsychiatric hospitalizations for persons with schizophrenia

Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
General hospital psychiatry (Impact Factor: 2.61). 07/2010; 32(4):419-25. DOI: 10.1016/j.genhosppsych.2010.04.006
Source: PubMed


Persons with schizophrenia comprise a vulnerable population that may be disproportionately susceptible to medical injuries. The objective of this study was to determine the association between diagnosis of schizophrenia and adverse events during non-psychiatric hospitalizations.
We studied U.S. hospital discharges from 2002-2007 using the Nationwide Inpatient Sample. We determined the nationally weighted association of schizophrenia with the Agency for Healthcare Research and Quality's Patient Safety Indicators after adjusting for patient, hospitalization, and hospital characteristics.
There were 269,387 non-psychiatric hospitalizations with schizophrenia, and 37,092,651 without. Hospitalizations with schizophrenia had elevated adjusted odds ratios for PSIs compared with those without schizophrenia for decubitus ulcer (1.43, 95% CI: 1.36-1.51); infection from medical care (1.19, 95% CI: 1.08-1.30); postoperative respiratory failure (1.96, 95% CI: 1.67-2.30); sepsis (1.59, 95% CI: 1.25-2.02); and pulmonary embolism/deep venous thrombosis (1.23, 95% CI: 1.13-1.35). Adjusted odds ratios for iatrogenic pneumothorax (1.12, 95% CI: 0.94-1.33) and postoperative hemorrhage (1.07, 95% CI: 0.88-1.31) were not significantly different in persons with schizophrenia, while the adjusted OR for accidental puncture (OR=0.66, 95% CI: 0.58-0.74) was reduced in persons with schizophrenia.
Persons with schizophrenia are more likely to experience the most common types of medical injuries. Improved understanding of factors related to hospital quality of care and outcomes in this group will be important to plan interventions to enhance patient safety for persons with schizophrenia.

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    • "Delays in medical diagnosis and under-recognition of medical conditions in people with severe mental illness suggest that these people might receive less than adequate care (Jeste et al. 1996). Patients with schizophrenia who are hospitalized due to medical conditions, for example, are reportedly more likely to experience decubitus ulcers, infections from medical care, and postoperative respiratory failure (Bouza & Pez-Cuadrado 2010; Daumit et al. 2006; Khaykin et al. 2010). Patients with physical health conditions can also develop mental illness and mental distress. "
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