Whatever happens to trauma patients who leave against medical advice?

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 pa...

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Bibliographic Details
Published in:The American journal of surgery 2016-04, Vol.211 (4), p.677-683
Main Authors: Olufajo, Olubode A., M.D., M.P.H, Metcalfe, David, L.L.B., M.B.Ch.B, Yorkgitis, Brian K., D.O, Cooper, Zara, M.D., M.Sc, Askari, Reza, M.D, Havens, Joaquim M., M.D, Brat, Gabriel A., M.D., M.Sc, Haider, Adil H., M.D., M.P.H, Salim, Ali, M.D
Format: Article
Language:English
Subjects:
Adult
Against medical advice
Age
California
Comorbidity
Confidence intervals
Demography
Drug abuse
Ethnicity
Female
Fractures
Humans
Injuries
Injury Severity Score
Location
Male
Mortality
Patient Discharge - statistics & numerical data
Patient Readmission - statistics & numerical data
Patients
Readmission
Risk Factors
Surgery
Teaching hospitals
Trauma
Trauma centers
Treatment Refusal
Wounds and Injuries - therapy
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Summary: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.
ISSN:0002-9610
1879-1883
DOI:10.1016/j.amjsurg.2015.11.016