Baylor College of Medicine, Houston, Texas.
Baylor College of Medicine, Houston, Texas.
J Am Acad Child Adolesc Psychiatry. 2024 Sep;63(9):908-918. doi: 10.1016/j.jaac.2023.09.554. Epub 2024 Jan 25.
Little is known about factors associated with discharge against medical advice (DAMA) in adolescent acute care hospitalization for suicidal ideation (SI) and suicide attempt (SA). Our study seeks to determine whether certain socioeconomic factors or hospital characteristics are associated with DAMA in this population.
This retrospective cross-sectional study used data from the National Inpatient Sample from the 2015 fourth quarter to 2019. We included children 10 to 19 years of age hospitalized with a primary or secondary International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis of SI or SA. Exposures were patient socio-demographics and hospital characteristics. The outcome was DAMA. Logistic regression generated odds ratios (ORs) with 95% CIs to measure the association between each patient and hospital characteristics and DAMA.
Of 476,755 hospitalizations meeting inclusion criteria, 3,825 (0.8%) were DAMA. After adjusting for socio-demographics and hospital characteristics, predictive factors for DAMA were age 16 to 19 years (OR = 1.41; CI = 1.08-1.82), self-pay status (OR = 1.43; CI = 1.12-1.83), hospital region South and West (OR = 1.55; CI = 1.10-2.20 and OR = 1.79; CI = 1.26-2.54, respectively), and urban non-teaching status of the hospital (OR = 1.90; CI = 1.42-2.55). Hispanic patients were less likely to be DAMA (OR = 0.66; CI = 0.51-0.85).
This study utilized retrospective data from the National Inpatient Sample (2015 to 2019) to determine predictive factors for discharge against medical advice (DAMA) for youth, aged 10 to 19 years old, hospitalized for suicidal ideation or suicide attempt. Of 476,755 hospitalizations for suicidality, 3,825 (0.8%) were discharged against medical advice. Correlates of discharge against medical advice included age 16 to 19 years, self-pay status, admission to an urban non-teaching hospital, or a hospital located in the South or West Regions of the United States. Hispanic patients were less likely to be discharged against medical advice with no other racial/ ethnic differences observed.
Variations in DAMA probabilities by age, insurance status, hospital teaching status, and hospital regions suggest a need for a better understanding of this uncommon outcome.
对于因自杀意念（SI）和自杀企图（SA）而在青少年急症护理住院治疗中与提前出院（DAMA）相关的因素知之甚少。我们的研究旨在确定在该人群中，某些社会经济因素或医院特征是否与 DAMA 相关。
这是一项回顾性的横断面研究，使用了 2015 年第四季度至 2019 年期间国家住院患者样本的数据。我们纳入了年龄在 10 至 19 岁之间，因 SI 或 SA 的主要或次要国际疾病分类、第十次修订版临床修正诊断而住院的儿童。暴露因素为患者的社会人口统计学特征和医院特征。结果为 DAMA。逻辑回归生成比值比（OR）及其 95%置信区间，以衡量每个患者和医院特征与 DAMA 之间的关联。
在符合纳入标准的 476755 例住院患者中，有 3825 例（0.8%）提前出院。在调整社会人口统计学特征和医院特征后，DAMA 的预测因素为 16 至 19 岁年龄组（OR=1.41；95%CI=1.08-1.82）、自费状态（OR=1.43；95%CI=1.12-1.83）、医院位于南部和西部（OR=1.55；95%CI=1.10-2.20 和 OR=1.79；95%CI=1.26-2.54），以及医院为城市非教学状态（OR=1.90；95%CI=1.42-2.55）。西班牙裔患者不太可能提前出院（OR=0.66；95%CI=0.51-0.85）。
按年龄、保险状况、医院教学状况和医院区域划分的 DAMA 概率差异表明，需要更好地了解这一罕见结局。
