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Factors associated with pediatric trauma patients leaving against medical advice
Ali Makhdoom1, Abimbola Pratt2, Yen-Hong Kuo3
1Hackensack Meridian School of Medicine, Nutley, NJ, USA.
Insights
Discharge against medical advice (AMA) is more common in Black pediatric trauma patients, those with self-pay insurance, and older children. Addressing these disparities is crucial for improving pediatric trauma care.
Area of Science:
- Trauma surgery
- Pediatric emergency medicine
- Health services research
Background:
- Discharge against medical advice (AMA) is associated with adverse patient outcomes and increased healthcare costs.
- Limited research exists on AMA discharge specifically within the pediatric trauma population.
- Understanding risk factors for AMA discharge in pediatric trauma is essential for targeted interventions.
Purpose of the Study:
- To identify and analyze the risk factors associated with pediatric trauma patients leaving against medical advice.
- To explore demographic, clinical, and injury-related characteristics that predict AMA discharge in children.
Main Methods:
- Retrospective analysis of pediatric trauma patients (age <18) from the National Trauma Data Bank (2017-2019).
- Inclusion criteria: pediatric trauma patients; data points analyzed: age, race, sex, Glasgow Coma Scale, trauma type, insurance, Abbreviated Injury Scale.
- Statistical analysis: Multiple Logistic Regression models to determine associations with AMA discharge.
Main Results:
- Black pediatric trauma patients exhibited a higher likelihood of AMA discharge compared to non-Black patients (OR 1.987).
- Patients with self-pay insurance (OR 1.759) and blunt trauma (OR 1.683) were more prone to AMA discharge.
- Increasing age correlated with higher AMA discharge odds (OR 1.150 per year), while severe abdominal or lower extremity injuries decreased this likelihood.
Conclusions:
- Race, insurance status, injury type, and patient age are significant predictors of AMA discharge in pediatric trauma.
- Black pediatric trauma patients have a disproportionately higher rate of AMA discharge, suggesting racial disparities.
- Future interventions should focus on addressing racial and socioeconomic factors to reduce AMA discharge rates in pediatric trauma care.
Background:
Discharge against medical advice (AMA) leads to worse patient outcomes, increased readmission rates, and higher cost. However, AMA discharge has received limited study, particularly in pediatric trauma patients. Our objective was to explore the risk factors associated with leaving AMA in pediatric trauma patients.
Methods:
We performed a retrospective analysis on pediatric trauma patients from 2017 to 2019 using the National Trauma Data Bank. We examined patient characteristics including age (<18 years), race, sex, Glasgow Coma Scale, trauma type, primary payment methods, and Abbreviated Injury Scale. Multiple Logistic Regression models were utilized to determine characteristics associated with leaving AMA.
Results:
Of the 224,196 pediatric patients included in the study, 238 left AMA (0.1%). Our study showed black pediatric trauma patients were more likely to leave AMA compared to nonblack patients (OR 1.987, 95% CI 1.501 to 2.631). Patients with self-pay coverage were more likely to leave AMA than those with other insurance coverages (OR 1.759, 95% CI 1.183 to 2.614). Blunt trauma patients were more likely to leave AMA than those with penetrating trauma (OR 1.683, 95% CI 1.216 to 2.330). Every one-year increase in age led to 15% increase in odds of AMA discharge (OR 1.150, 95% CI 1.115 to 1.186). Pediatric patients with severe abdominal injuries were less likely to leave AMA compared to those with mild abdominal injuries (OR 0.271, 95% CI 0.111 to 0.657). Patients with severe lower extremity injury were less likely to leave AMA compared to those with mild lower extremity injuries (OR 0.258, 95% CI 0.127 to 0.522).
Conclusion:
Race, insurance, injury type, and age play a role in AMA discharge of pediatric trauma patients. Black pediatric trauma patients have ∼ double the AMA discharge rate of nonblack patients. AMA discharge remains relevant, and addressing racial and socioeconomic factors provide opportunities for future interventions in pediatric trauma care.
Level Of Evidence:
III, retrospective study.
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