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Predictors of discharge against medical advice in adult trauma patients
Predictors of discharge against medical advice in adult trauma patients
- Source :
- The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland. 18(1)
- Publication Year :
- 2019
-
Abstract
- Patients 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.The 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.Of 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).In 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.
- Subjects :
- Adult
Counseling
Male
medicine.medical_specialty
Logistic regression
Patient Readmission
California
03 medical and health sciences
0302 clinical medicine
Risk Factors
parasitic diseases
medicine
Humans
030212 general & internal medicine
Male gender
Aged
Retrospective Studies
business.industry
Incidence
Against medical advice
030208 emergency & critical care medicine
Trauma quality improvement program
Middle Aged
Patient Discharge
Survival Rate
Mechanism of injury
Emergency medicine
Wounds and Injuries
Surgery
Female
business
Subjects
Details
- ISSN :
- 1479666X
- Volume :
- 18
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
- Accession number :
- edsair.doi.dedup.....419e3275a26bbdf25ed45efb73c77622