Study Design: Retrospective cohort study. Objective: To evaluate the association between psychiatric comorbidity and in-hospital outcomes in traumatic spinal fracture patients, as well as the dose-response relationship between psychiatric burden and outcomes. Summary of Background Data: Psychiatric comorbidities are prevalent among trauma patients and associated with worse acute outcomes, yet few studies have examined this relationship in spinal fracture patients specifically, and none have assessed the cumulative effect of multiple psychiatric conditions. Methods: Traumatic spinal fracture patients were identified from the 2018 to 2023 National Trauma Data Bank using ICD-10 codes. Psychiatric comorbidity was characterized as a binary indicator and a Psychiatric Burden score reflecting the number of distinct diagnostic categories. Propensity score matching (1:2) was performed to compare patients with and without psychiatric comorbidity on length of stay (LOS), ventilator use, ventilator duration, mortality, and severe sepsis. Dose-response analyses were conducted in the psychiatric subgroup using multivariate regression with Psychiatric Burden as a continuous predictor. Results: Of 940,733 analytic patients, 4731 (0.50%) had ≥1 psychiatric comorbidity. After matching, psychiatric comorbidity was associated with 22.8% longer LOS (95% CI: 19.2–26.5%, P <0.001) and higher odds of ventilator use (OR: 1.11, 95% CI: 1.01–1.22, P =0.025). Each additional psychiatric diagnostic category was associated with 8.6% longer LOS (95% CI: 4.7–12.7%, P <0.001) and lower odds of ventilator use (OR: 0.87, 95% CI: 0.76–0.98, P =0.024). Conclusion: Psychiatric comorbidity is an independent and dose-dependent predictor of prolonged hospitalization in traumatic spinal fracture patients, with higher psychiatric burden associated with less invasive respiratory management. A count of psychiatric diagnoses at admission may serve as a low-cost criterion for prioritizing early behavioral health involvement. Prospective evaluation is needed to determine whether such an intervention alters in-hospital outcomes. Levels of Evidence: Level III.

Introduction: Stroke remains the second leading cause of death worldwide and a major cause of long-term disability. Approximately 87% of strokes are ischemic, and 30% of these are large vessel occlusions (LVOs). Early recognition of LVOs and rapid transport to a comprehensive stroke center (CSC) capable of MT are critical to improving outcomes. Accurately predicting LVOs in prehospital settings remains chall29enging. Several triage scales have been developed to aid early detection, but their diagnostic accuracy varies across studies. This study compares the performance of commonly used prehospital LVO scales by pooling published data to identify which tools best support emergency medical services (EMS) in optimizing triage and improving outcomes. Methods: A systematic search, following the Cochrane Library, of PubMed, Scopus, and Web of Science identified studies evaluating prehospital LVO triage scales using standardized search terms. Diagnostic accuracy measurements were extracted, and a pooled analysis was completed to compare scores. Results: From 743 unique articles, 15 studies evaluating prehospital large vessel occlusion (LVO) triage scales were included. Pooled log diagnostic odds ratios (DORs) indicated that RACE demonstrated the highest discriminative performance (2.367 [1.943–2.792]), followed by LAMS (2.228 [1.987–2.470]). The lowest scores were from the PASS (1.992 [1.758–2.227]) and C-STAT (1.886 [1.652–2.119]) scales. Conclusions: Among prehospital triage scales, RACE demonstrated the highest accuracy for LVO detection, followed by LAMS and G-FAST. Variation in scores may indicate inconsistency in performing the tests or the complexity of the questions. These findings support a personalized approach to choosing an LVO identification scale based on the resources available.