Whatever happens to trauma patients who leave against medical advice?

Olubode A Olufajo; David Metcalfe; Brian K Yorkgitis; Zara Cooper; Reza Askari; Joaquim M Havens; Gabriel A Brat; Adil H Haider; Ali Salim

doi:10.1016/j.amjsurg.2015.11.016

Whatever happens to trauma patients who leave against medical advice?

Am J Surg. 2016 Apr;211(4):677-83. doi: 10.1016/j.amjsurg.2015.11.016. Epub 2015 Dec 31.

Authors

Olubode A Olufajo¹, David Metcalfe², Brian K Yorkgitis³, Zara Cooper⁴, Reza Askari⁴, Joaquim M Havens⁴, Gabriel A Brat³, Adil H Haider⁴, Ali Salim⁴

Affiliations

¹ Division of Trauma, Burn and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health, 1620 Tremont Street, Boston, MA 02121, USA. Electronic address: oao777@mail.harvard.edu.
² Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health, 1620 Tremont Street, Boston, MA 02121, USA.
³ Division of Trauma, Burn and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
⁴ Division of Trauma, Burn and Surgical Critical Care, Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA; Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School and Harvard T.H. Chan School of Public Health, 1620 Tremont Street, Boston, MA 02121, USA.

PMID: 26827185
DOI: 10.1016/j.amjsurg.2015.11.016

Abstract

Background: Although trauma patients are frequently discharged against medical advice (AMA), the fate of these patients remains mostly unknown.

Methods: Patients with traumatic injuries were identified in the California State Inpatient Database, 2007 to 2011. Readmission characteristics of patients discharged AMA were compared with patients discharged home.

Results: There were 203,756 (75.65%) patients discharged home and 4,480 (1.66%) discharged AMA. Compared with those discharged home, patients discharged AMA had significantly higher 30-day readmission rates (17.12% vs 6.75%), rates of multiple readmissions (3.83% vs 1.12%), and likelihood of being readmitted at different hospitals (44.83% vs 33.82%) (all P < .001). The commonest reasons for readmission in patients discharged AMA were psychiatric conditions [adjusted odds ratio: 1.67 (1.21 to 2.27)].

Conclusions: Discharge AMA is associated with multiple readmissions and higher rates of readmissions at different hospitals. Early identification of vulnerable patients and improved modalities to prevent discharge AMA among these patients may reduce the negative outcomes associated with discharge AMA among trauma patients.

Keywords: Against medical advice; Location; Readmission; Risk factors; Trauma.

MeSH terms

Adult
California
Demography
Female
Humans
Injury Severity Score
Male
Patient Discharge / statistics & numerical data*
Patient Readmission / statistics & numerical data*
Risk Factors
Treatment Refusal*
Wounds and Injuries / therapy*