Work

Discharge against medical advice among pediatric patients

Year: 2025

Type: article

Abstract: OBJECTIVES: To investigate the incidence, parental reasons, and predictors of emergency room (ER) revisits following discharge against medical advice (DAMA) in a pediatric center in Saudi Arabia. METHODS: This retrospective cohort study was conducted between January 2020 and December 2024 at a tertiary care hospital. Pediatric patients aged 0-14 years who signed the DAMA during ER visits were included. Medical records of patients with DAMA were reviewed to collect demographic data, diagnoses, reasons for DAMA, and outcomes. RESULTS: Among 446,251 ER visits, 2,336 (0.52%, 95% CI: 0.50%-0.55%) involved caregiver-signed DAMA. These rates ranged from 0.45% (2020) to 0.69% (2023). The majority were Saudi (98.8%), male (55.3%), and under the age of 2 (43.5%). Most patients were triaged three/urgent (63.9%), with infections being the most frequent presenting complaint (52.8%). The documented reasons for DAMA included long waiting times (41.6%) and issues with caregiver availability (18.9%). Within 30 days, 567 patients (24.3%, 95% CI: 22.3%-26.3%) revisited the ER; of these, 33.9% required hospitalization. DAMA was associated with higher revisit risk in children <2 years (OR=1.23, 95% CI: 1.01-1.50) and those presenting with infectious symptoms (OR=1.43, 95% CI: 1.17-1.75). CONCLUSION: DAMA is a significant challenge in pediatric emergency care. Targeted interventions are crucial for reducing DAMA rates, particularly among high-risk infants and children with infections. Hospitals can improve outcomes by enhancing efficiency, caregiver education, and policies to prevent premature discharge.

Source: Saudi Medical Journal

DOI: 10.15537/smj.2025.46.12.20250487