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Children Discharged Against Medical Advice and Their Outcome in a Public Hospital in India: A Prospective Cohort
Shilpi Jha1, Devendra Mishra2, Anurag Agarwal1
1Department of Pediatrics, Department of Medical Education, Maulana Azad Medical College and Lok Nayak Hospital (Delhi University), Delhi, 110002, India.
Insights
Discharge against medical advice (DAMA) in children is linked to incomplete immunization, chronic illness, and high Pediatric Early Warning Scores (PEWS). High readmission and mortality rates highlight the need for interventions addressing DAMA causes.
Area of Science:
- Pediatric inpatient care
- Public health
- Clinical outcomes
Background:
- Discharge against medical advice (DAMA) is a significant concern in pediatric healthcare.
- Understanding DAMA predictors and outcomes is crucial for improving patient safety.
Purpose of the Study:
- To identify factors associated with DAMA in children.
- To determine the one-month readmission and mortality rates for children discharged against medical advice.
Main Methods:
- Prospective cohort study of children aged 6 months to 12 years admitted to an inpatient ward.
- Data collection included clinical, demographic, and DAMA reason information via structured interviews.
- One-month follow-up of DAMA patients was conducted telephonically.
Main Results:
- 5.2% of children (28/538) were discharged against medical advice (DAMA).
- Predictors of DAMA included partial/unimmunized status, chronic disease, and higher Pediatric Early Warning Score (PEWS).
- Hospital-related reasons (60.7%), disease-related reasons (32.1%), and sociodemographic reasons (25%) were primary DAMA contributors. 10/25 (40%) DAMA patients were readmitted, and 5/25 (20%) died within one month.
Conclusions:
- High readmission and mortality rates underscore the critical need for targeted interventions.
- Addressing the multifaceted causes of DAMA is essential for improving pediatric patient outcomes.
Objectives:
To determine the factors associated with discharge against medical advice (DAMA), and the readmission and mortality rate at one-month follow-up among these children.
Methodology:
This prospective cohort study enrolled consecutive children (6 months-12 years) from one designated inpatient ward. Clinical and demographic data, and information about reasons for DAMA were collected using a structured interview. Outcome of DAMA patients was assessed telephonically at one month after discharge.
Results:
Out of 538 children, 28 (5.2%) obtained DAMA. Predictors of DAMA on multivariate analysis were partial/unimmunized status, underlying chronic disease, and higher Pediatric Early Warning Score (PEWS) at admission. The most common contributors to DAMA included hospital-related reasons (n = 17, 60.7%), disease-related reasons (n = 9, 32.1%), and sociodemographic reasons (n = 7, 25%). A total of 25 children could be followed up at one month; of these 10 were readmitted at another hospital, and 5 died.
Conclusions:
The high rates of readmission and mortality among these children emphasize the need for targeted interventions to address the underlying causes of DAMA.
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