Predictors of discharge against medical advice in adult trauma patients |
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| Institution: | 1. University of California, Irvine, Department of Surgery, Division of Trauma, Burns and Surgical Critical Care, Orange, CA, USA;2. University of Southern California, Department of Anesthesiology, Los Angeles, CA, USA;1. Centre for Healthcare Education Research and Innovation, University of Aberdeen, UK;2. Department of Colorectal Surgery, Aberdeen Royal Infirmary, UK;3. Department of Orthopaedic Surgery, Queen Alexandra Hospital, Portsmouth, UK;4. The Royal College of Surgeons of England, London, UK;5. Royal College of Surgeons in Ireland, Dublin, Ireland;6. The Royal College of Surgeons of Edinburgh, Edinburgh, UK;7. Medical Statistics Team, University of Aberdeen, UK;8. Department of Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, UK;1. General Surgical Unit, Belfast City Hospital, 51 Lisburn Road, Belfast, BT9 7AB, Northern Ireland, United Kingdom;2. Queen''s University Belfast, University Road, Belfast, BT9 1NN, Northern Ireland, United Kingdom;3. Pathology, Belfast City Hospital, 51 Lisburn Road, Belfast, BT9 7AB, Northern Ireland, United Kingdom;4. Renal Transplant Unit, Belfast City Hospital, 51 Lisburn Road, Belfast, BT9 7AB, Northern Ireland, United Kingdom |
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| Abstract: | BackgroundPatients who leave against medical advice (AMA) have higher readmission rates and mortality. However, little is known about the characteristics of trauma patients that leave AMA. The purpose of this study was to identify predictors for leaving AMA in adult trauma patients.MethodsThe Trauma Quality Improvement Program database was queried between 2010 and 2016 for patients ≥18 years of age presenting after trauma. Two groups were compared: those who left AMA and those that did not. Bivariate analysis using Chi-squared and Mann–Whitney U tests was performed. A multivariable logistic regression analysis was performed to identify predictors for leaving AMA.ResultsOf 1,403,466 trauma patients identified, 10,659 (0.76%) left AMA. Patients that left AMA were younger (median age, 48 vs. 53 years-old, p < 0.001), more often male (82.1% vs. 62.8%, p < 0.001), more likely to be black (23.6% vs. 14.9%, p < 0.001), and more likely to be uninsured (27.0% vs. 12.3%, p < 0.001). Patients leaving AMA were more likely to test positive for alcohol (36.1% vs. 17.4%, p < 0.001) or drug use (36.0% vs. 17.2%, p < 0.001) at time of admission. On multivariable logistic regression, the strongest predictors for leaving AMA were: no insurance (OR 2.00, CI 1.88–2.14, p < 0.001), alcohol use (OR 1.85, CI 1.74–1.96, p < 0.001) or drug use (OR 1.83, CI 1.72–1.94, p < 0.001), male gender (OR 1.83, CI 1.71–1.97, p < 0.001), and stab mechanism of injury (OR 1.58, CI 1.43–1.73, p < 0.001).ConclusionIn adult trauma patients, male gender, stab mechanism of injury, being uninsured, and alcohol/drug use were strong predictors of leaving AMA. The risk factors identified may help in developing strategies aimed at preventing trauma patients from leaving AMA. |
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| Keywords: | Discharge against medical advice Trauma Predictors Leave against medical advice |
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