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

Abstract

Background: Patients who leave hospital against medical advice (AMA) may be at risk of adverse health outcomes, medical complications, and readmission. In this study, we examined the characteristics of patients who left AMA after traumatic brain injury (TBI), their rates of follow-up visits, and readmission. Methods: We retrospectively studied 106 consecutive patients who left the tertiary trauma center AMA (1.8% of all admitted patients with a TBI). Preinjury health and social issues, mechanism of injury, computed tomography findings, and injury markers were collected. They were correlated to compliance with follow-up visits and unplanned emergency room (ER) visits and readmission rates. Results: The most prevalent premorbid health or social-related issues were alcohol abuse (33%) and assault as a mechanism of trauma (33%). Only 15 (14.2%) subjects came to follow-up visit for their TBI. Sixteen (15.1%) of the 106 subjects had multiple readmissions and/or ER visits related to substance abuse. Seven (6.6%) had multiple readmissions or ER visits with psychiatric reasons. Those patients with multiple readmissions and ER visits showed in higher proportion preexisting neurological condition (p = 0.027), homelessness (p = 0.012), previous neurosurgery (p = 0.014), preexisting encephalomalacia (p = 0.011), and had a higher ISS score (p = 0.014) than those who were not readmitted multiple times. Conclusions: The significantly increased risks of multiple follow-up visits and readmission among TBI patients who leave hospital AMA are related to a premorbid vulnerability and psychosocial issues. Clinicians should target AMA TBI patients with premorbid vulnerability for discharge transition interventions.RÉSUMÉ: Taux de visite de suivi et de réhospitalisation chez des patients atteints d'une lésion cérébrale traumatique qui quittent l'hôpital contre avis médical. Contexte: Les patients qui quittent l'hôpital contre avis médical (CAM) sont à risque d'encourir des problèmes de santé, des complications médicales et d'être réhospitalisés. Dans cette étude, nous examinons les caractéristiques des patients qui ont quitté l'hôpital CAM suite à une lésion cérébrale traumatique (LCT) ainsi que le taux de visite de suivi et de réhospitalisation. Méthodologie: Nous avons étudié rétrospectivement les dossiers de 106 patients consécutifs qui ont quitté CAM un centre de soins tertiaires en traumatologie, soit 1,8% de tous les patients admis suite à une LCT. Nous avons colligé les problèmes socio-sanitaires, le mécanisme de la blessure, les constatations à la tomodensitométrie et les marqueurs de la blessure. Nous les avons corrélés à la fidélité aux visites de suivi, aux visites non planifiées au service des urgences et au taux de réhospitalisation. Résultats: Les problèmes les plus fréquents concernant la santé ou la situation sociale étaient l'abus d'alcool (33%) et l'agression comme cause du traumatisme (33%). Seulement 15 des sujets (14,2%) se sont présentés à la visite de suivi pour leur LCT. Seize des 106 sujets (15,1%) on...

Discharge against medical advice among neurological patients: Characteristics and outcomes

“…Our study also demonstrated a rate of DAMA of 1.73 percent among admitted TBI patients. In a retrospective matched‐cohort study of 656 patients admitted to Montreal General Hospital between 2010 and 2011, Marcoux et al 6 found that 1.8 percent of patients admitted for TBI were discharged AMA. We confirmed these prevalences in a larger, contemporary, nationally representative US cohort.…”

“…Neurological disorders constitute 10.2 percent of the global burden of disease and 16.8 percent of total deaths 5 . A higher risk of DAMA has been found in patients with comorbid neurological conditions 6 . Furthermore, compared to the general population, neurological patients have increased rates of comorbid psychiatric conditions, 7 and impaired cognition and executive function 8 .…”

“…Furthermore, compared to the general population, neurological patients have increased rates of comorbid psychiatric conditions, 7 and impaired cognition and executive function 8 . Current studies on DAMA in the neurological population are limited by small sample sizes or geographically limited samples that are more prone to regional variation 6,9 . This is a need to better identify neurological patients who are (a) at risk of DAMA, and (b) at risk of poor outcomes related to DAMA, for potential receipt of interventions to improve outcomes.…”

Effects of Age and Sex on Hospital Readmission in Traumatic Brain Injury

“…Studies show that patients leaving hospitals against medical advice after TBI had higher rates of readmission 12,13 . Corrigan and colleagues (2014) 14 pointed out that age-specific interventions are needed to reduce post-acute inpatient rehabilitation mortality in TBI.…”

Retrospective evaluation of patients who leave against medical advice in a tertiary teaching care institute

“…Our patient population was mix up of medical and surgical patients with medical patients outnumbering the surgical patients. The problem of LAMA has been studied in an array of patients, but most of the literature relates to psychiatric illness or illicit drug abusers,[ 7 12 ] heart disease,[ 13 14 ] trauma,[ 15 16 ] cirrhosis,[ 17 18 ] pregnant, and postpartum patients. [ 19 20 ] Some studies believe that the developing countries have higher rate of LAMA.…”