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Whatever happens to trauma patients who leave against medical advice?

  • Olubode A. Olufajo
    Correspondence
    Corresponding author. Tel.: +1-617-525-7300; fax: +1-617-566-9549.
    Affiliations
    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
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  • David Metcalfe
    Affiliations
    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
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  • Brian K. Yorkgitis
    Affiliations
    Division of Trauma, Burn and Surgical Critical Care, Department of Surgery, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA
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  • Zara Cooper
    Affiliations
    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
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  • Reza Askari
    Affiliations
    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
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  • Joaquim M. Havens
    Affiliations
    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
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  • Gabriel A. Brat
    Affiliations
    Division of Trauma, Burn and Surgical Critical Care, Department of Surgery, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA
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  • Adil H. Haider
    Affiliations
    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
    Search for articles by this author
  • Ali Salim
    Affiliations
    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
    Search for articles by this author
Published:December 31, 2015DOI:https://doi.org/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

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