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Discharge against medical advice in pediatrics: a 10-year retrospective analysis in a tertiary care center
Mohammed Albalawi1, Kim Sadler2, Gassan Abudari2
1From the Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.
Insights
Discharge Against Medical Advice (DAMA) in children is a significant issue, particularly for those with chronic conditions. Improving documentation and protocols is crucial for managing pediatric DAMA effectively.
Area of Science:
- Pediatric healthcare
- Patient safety
- Healthcare management
Background:
- Limited data exists on pediatric Discharge Against Medical Advice (DAMA), with most research from low- and middle-income countries.
- Financial burdens are a significant driver of DAMA in some regions.
- Pediatric DAMA poses increased risks of morbidity and mortality.
Purpose of the Study:
- To characterize pediatric DAMA in Riyadh, Saudi Arabia.
- To identify predictors of DAMA in children under 14 years.
- To analyze reasons and outcomes associated with pediatric DAMA.
Main Methods:
- Retrospective study design.
- Data collected from a tertiary care center in Riyadh.
- Included all pediatric DAMA episodes between 2012 and 2022.
Main Results:
- 355 DAMA episodes analyzed; overall prevalence was 0.4%.
- Children with chronic or life-threatening conditions (78%) were more likely to DAMA.
- Key DAMA reasons included treatment disagreement (14.9%) and social factors (12.6%).
- Recurrence risk increased with pre-existing conditions (OR: 8.2) and during treatment (OR: 1.9).
Conclusions:
- Pediatric DAMA is associated with significant underlying health issues.
- Inconsistent documentation hinders effective management of DAMA.
- Standardized protocols and improved documentation are needed to address pediatric DAMA.
Background:
There is still limited data on Discharge Against Medical Advice (DAMA) in the pediatric population. Most research comes from low-and middle-income countries, where the financial burden associated with medical care is often an important reason to leave a healthcare facility prematurely. Discharge against medical advice in the children's population is considered a significant issue that may lead to an increased risk of morbidity and mortality.
Objectives:
Describe the characteristics and predictors of DAMA in children over ten years in in Riyadh, Saudi Arabia.
Design:
Retrospective.
Setting:
Tertiary care center.
Patients And Methods:
This study included all patients aged <14 years who had DAMA during all admissions between 1 January 2012, and 31 December 2022.
Main Outcome Measures:
Data was retrieved from medical records and included 1) sociodemographic data, 2) medical history and clinical characteristics, 3) utilization of services during the admission leading to DAMA, and 4) interventions provided to prevent departure.
Sample Size:
355 DAMA episodes.
Results:
Males accounted for 45.4%, and the average age was 4.4 years. The overall DAMA prevalence of was 0.4%. At baseline, 277 children (78%) had at least a chronic illness or severe baseline condition; 59% had a potential life-limiting or life-threatening condition. Reasons for DAMA included disagreement about the treatment plan (14.9%), social reasons (12.6%), and perception that the child's condition improved (5.6%). An increased risk of DAMA recurrence was associated with pre-existing severe or chronic medical conditions (OR: 8.2, P=.004) and a discharge during the treatment phase (OR: 1.9, P=.040).
Conclusions:
Despite inconsistent documentation, preventive measures included the involvement of healthcare providers, social services, and patient relations. The study highlights the need for standardized protocols and improved documentation practices to effectively address discharge against medical advice.
Limitations:
Needs to moderate documentation quality of DAMA episodes. The study was limited to a single center, which may affect the generalizability. Children might also have presented to receive care in another facility post-DAMA.
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