Characteristics of patients with acute traumatic brain injury discharged against medical advice in a Level 1 urban trauma centre

Abstract

Knowing the profile of patients with TBI leaving AMA hospitalized in an urban Level 1 Trauma centre will help in the development of effective strategies based on patient needs, values and pre-injury psychosocial situation to encourage them to complete their treatment course in hospital.

Discharge Against Medical Advice in Traumatic Brain Injury: Follow-Up and Readmission Rate

“…The present study showed a rate of discharge AMA of 1.8% amongst admitted TBI patients, which is consistent with the rates reported in the literature for TBI 9 11 It also showed that single male patients who present with history of alcohol abuse were representative of the TBI patients who leave AMA; these findings were in accordance with previous studies, 5 - 8 including our previous study on the same population 11 . In addition, one-third of our cohort was involved in an assault.…”

“…[9][10][11] It also showed that single male patients who present with history of alcohol abuse were representative of the TBI patients who leave AMA; these findings were in accordance with previous studies, [5][6][7][8] including our previous study on the same population. 11 In addition, one-third of our cohort was involved in an assault. Our institution being in a large urban area, some characteristics such as history of alcohol abuse and assault may be found in a greater proportion in our source population than in a trauma center located in a more rural setting.…”

“…[5][6][7][8] In the TBI population, previous studies have shown that between 0.93% and 2.84% of TBI patients, from acute care to rehabilitation settings, discharged themselves AMA. [9][10][11] Similar patient's characteristics have been reported in the TBI population. In these cases, younger age, unemployment, alcohol/ drug abuse history, intentional injuries (self-inflicted and otherinflicted injury versus unintentional injury), and homelessness were found to be significant predictors for discharge AMA after TBI.…”

“…In these cases, younger age, unemployment, alcohol/ drug abuse history, intentional injuries (self-inflicted and otherinflicted injury versus unintentional injury), and homelessness were found to be significant predictors for discharge AMA after TBI. [10][11][12][13][14][15] Several adverse consequences have been associated to discharge AMA, such as medical and psychosocial complications, frequent readmissions and higher mortality, regardless of the underlying medical reason for admission. 5,7,[16][17][18][19][20][21][22] However, mortality rates following AMA discharge have been limited to short term only.…”

Introducing the model of cognitive-communication competence: A model to guide evidence-based communication interventions after brain injury

“…International standards for cognitive-communication intervention recommend that rehabilitation of individuals with cognitive-communication disorders be grounded in analysis of an individual's unique characteristics, needs, life contexts, goals, and skills (24). Pre-injury factors that have been found to influence communication outcome include age and stage of neurological and cognitive development (114)(115)(116)(117); education, learning skills, learning disability (118), sex (118-120); mental health concerns, previous brain injury, or substance abuse (118,(121)(122)(123)(124).…”