Jha Shilpi, Mishra Devendra, Agarwal Anurag
Department of Pediatrics, Department of Medical Education, Maulana Azad Medical College and Lok Nayak Hospital (Delhi University), Delhi, 110002, India.
Indian Pediatr. 2025 Jun 4. doi: 10.1007/s13312-025-00108-3.
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.
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.
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.
The high rates of readmission and mortality among these children emphasize the need for targeted interventions to address the underlying causes of DAMA.
确定与违反医嘱出院（DAMA）相关的因素，以及这些儿童在1个月随访时的再入院率和死亡率。
这项前瞻性队列研究纳入了来自一个指定住院病房的连续儿童（6个月至12岁）。通过结构化访谈收集临床和人口统计学数据以及有关违反医嘱出院原因的信息。在出院1个月后通过电话评估违反医嘱出院患者的结局。
在538名儿童中，28名（5.2%）违反医嘱出院。多因素分析中违反医嘱出院的预测因素为部分/未免疫状态、潜在慢性病以及入院时较高的儿科早期预警评分（PEWS）。违反医嘱出院最常见的原因包括医院相关原因（n = 17，60.7%）、疾病相关原因（n = 9，32.1%）和社会人口学原因（n = 7，25%）。共有25名儿童在1个月时接受了随访；其中10名在另一家医院再次入院，5名死亡。
这些儿童较高的再入院率和死亡率强调了需要采取有针对性的干预措施来解决违反医嘱出院的根本原因。
