Predictors of discharge against medical advice in adult trauma patients.
Discharge against medical advice
Leave against medical advice
Predictors
Trauma
Journal
The surgeon : journal of the Royal Colleges of Surgeons of Edinburgh and Ireland
ISSN: 1479-666X
Titre abrégé: Surgeon
Pays: Scotland
ID NLM: 101168329
Informations de publication
Date de publication:
Feb 2020
Feb 2020
Historique:
received:
14
02
2019
revised:
10
04
2019
accepted:
11
04
2019
pubmed:
6
5
2019
medline:
13
11
2020
entrez:
7
5
2019
Statut:
ppublish
Résumé
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.
Sections du résumé
BACKGROUND
BACKGROUND
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.
METHODS
METHODS
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.
RESULTS
RESULTS
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).
CONCLUSION
CONCLUSIONS
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.
Identifiants
pubmed: 31056431
pii: S1479-666X(19)30041-1
doi: 10.1016/j.surge.2019.04.001
pii:
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
12-18Informations de copyright
Copyright © 2019 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.