Prevalence of discharge against medical advice and its associated demographic predictors among pediatric patients: A cross-sectional study of Saudi Arabia
Nesreen Suliman Alwallan1, Ahmad Mohammed Ishaque Al Ibrahim2, Wafa Elrasheed Osman Homaida1, Majid Alsalamah3, Saeed Mastour Alshahrani4, Badr F Al-Khateeb5, Salwa Bahkali6, Khalid Ibrahim Al-Qumaizi7, Paivi Toivola8, Ashraf El-Metwally9
1 Department of Emergency, Pediatric Emergency Section; King Abdullah Bin Abdulaziz University Hospital, Princess Nourah University, Riyadh, Saudi Arabia
2 King Abdullah Bin Abdulaziz University Hospital, Princess Nourah University; Department of Emergency, Adult Emergency Section, Riyadh, Saudi Arabia
3 Department of Emergency Medicine; King Saud bin Abdulaziz University for Health Sciences, Abha, Saudi Arabia
4 College of Applied Medical Sciences, King Khalid University, Abha, Saudi Arabia
5 King Saud bin Abdulaziz University for Health Sciences; Department of Family Medicine; College of Medicine, College of Public Health and Health Informatics, Riyadh, Saudi Arabia
6 Princess Nourah Bint Abdulrahman University, King Abdullah Bin Abdulaziz University Hospital, Riyadh, Saudi Arabia
7 College of Medicine, Al-Imam Muhammad Ibn Saud Islamic University, (IMSIU), Riyadh, Saudi Arabia
8 King Abdullah Specialist Children's Hospital, King Abdulaziz Medical City, Riyadh, Saudi Arabia
9 King Saud bin Abdulaziz University for Health Sciences; College of Medicine, College of Public Health and Health Informatics, Riyadh, Saudi Arabia; Department of Epidemiology and Biostatistics
Dr. Ashraf El-Metwally
Department of Epidemiology and Biostatistics, College of Public Health and Health Informatics, King Saud Bin Abdulaziz University for Health Sciences, Riyadh
Source of Support: None, Conflict of Interest: None
Background: Discharge against medical advice (DAMA) occurs when the patient or their caretaker leaves the hospital against the recommendation of their treating physician. DAMA may expose the children to a high risk of inadequate treatment, which may result in readmission, prolonged morbidity, and mortality. The study aimed to identify the predictors of DAMA in the emergency department (ED) within the pediatric age group.
Methods: This was a cross-sectional study. The study used the medical records of pediatric patients (n = 5609) that were admitted to the ED of King Abdullah Bin Abdulaziz University Hospital (KAAUH) in Riyadh, Saudi Arabia, during 2017 and 2018. Descriptive statistics, Chi-square, or Fisher's exact test were used. Unadjusted and adjusted odds ratios with their 95% CI were reported by performing logistic regression modeling.
Results: A significant interaction between age and gender was observed in the multivariate analysis after adjusting for the other covariates. The odds of DAMA for a 5-year-old female child were 4.43 times higher than those of a 5-year-old male child (P < 0.1).
Conclusions: The public should be educated about the consequences of DAMA. Continued health education and the promotion of child survival strategies at the community level, combined with an improvement in the socioeconomic conditions of the population, may further reduce DAMA and improve the chances of survival for children. Future studies should assess the socioeconomic status of the patients and estimate the cost that is incurred by the patients.