Impact of discharge against medical advice on emergency department revisits and prognosis among pneumonia patients recommended to be hospitalized in a general ward
- Author:
Myung Ha SEO
1
;
Won Young SUNG
;
Jang Young LEE
;
Won Suk LEE
;
Sang Won SEO
;
Keun Taek LEE
Author Information
1. Department of Emergency Medicine, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea
- Publication Type:Original Article
- From:Journal of the Korean Society of Emergency Medicine
2022;33(2):172-183
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
Objective:This study examined the clinical consequences of a discharge against medical advice (DAMA) among pneumonia patients recommended to be hospitalized in a general ward and identified the risk factors related to a revisit after DAMA.
Methods:This retrospective observational study included pneumonia patients who presented at a university hospital emergency department (ED) and were recommended to be hospitalized in a general ward between January 2017 and December 2019. A multivariate logistic regression analysis was performed to identify the risk factors related to a revisit after DAMA and mortality.
Results:In the ‘revisit after DAMA’ group, the mortality rate was higher than the ‘no DAMA admission’ group (6.9% vs. 2.1%, P=0.009). Among all admitted patients, DAMA was a risk factor for mortality (odds ratio [OR], 6.185; P=0.023). In the ‘revisit after DAMA’ group, sex (OR, 6.590; P=0.005), C-reactive protein (CRP) score (OR, 1.149; P=0.022), febrile symptoms (OR, 6.569; P=0.004), and dyspnea (OR, 5.480; P=0.002) were risk factors of revisit. Furthermore, in the ‘revisit after DAMA’ group, the CRP score of the 2nd ED visit was higher than that of the 1st ED visit (6.55±6.27 vs. 8.20±7.31, P=0.014).
Conclusion:This study shows that DAMA is one of the risk factors for mortality. When DAMA patients revisit, the severity of their pneumonia was observed to have increased.
