Children Discharged Against Medical Advice and Their Outcome in a Public Hospital in India: A Prospective Cohort Study.

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.