Alwallan Nesreen Suliman, Al Ibrahim Ahmad Mohammed Ishaque, Osman Homaida Wafa Elrasheed, Alsalamah Majid, Alshahrani Saeed Mastour, Al-Khateeb Badr F, Bahkali Salwa, Al-Qumaizi Khalid Ibrahim, Toivola Paivi, El-Metwally Ashraf
Department of Emergency, Pediatric Emergency Section, Riyadh, Saudi Arabia.
King Abdullah Bin Abdulaziz University Hospital, Princess Nourah University, Riyadh, Saudi Arabia.
Int J Crit Illn Inj Sci. 2021 Jul-Sep;11(3):112-116. doi: 10.4103/IJCIIS.IJCIIS_96_20. Epub 2021 Sep 25.
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.
This was a cross-sectional study. The study used the medical records of pediatric patients ( = 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.
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 ( < 0.1).
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.
当患者或其照顾者违背主治医生的建议离开医院时，就会发生违反医疗建议出院（DAMA）的情况。DAMA可能会使儿童面临治疗不足的高风险，这可能导致再次入院、病程延长和死亡。本研究旨在确定儿科年龄组急诊科中DAMA的预测因素。
这是一项横断面研究。该研究使用了2017年和2018年期间在沙特阿拉伯利雅得阿卜杜勒阿齐兹国王大学医院（KAAUH）急诊科住院的儿科患者（n = 5609）的病历。使用描述性统计、卡方检验或费舍尔精确检验。通过进行逻辑回归建模报告未调整和调整后的比值比及其95%置信区间。
在对其他协变量进行调整后的多变量分析中，观察到年龄和性别之间存在显著交互作用。5岁女童DAMA的几率比5岁男童高4.43倍（P < 0.1）。
应向公众宣传DAMA的后果。在社区层面持续开展健康教育和推广儿童生存策略，同时改善人群的社会经济状况，可能会进一步减少DAMA并提高儿童的生存几率。未来的研究应评估患者的社会经济状况并估计患者产生的费用。
