Discharge against medical advice (DAMA) in patients with long bone fractures at YEC: Epidemiological, clinical, evolutionary and medico-legal aspects

Abstract

Discharge against medical advice (DAMA) is a term used in healthcare establishments when a patient leaves a hospital against the advice of their doctor.The aim of this study was to describe the epidemiological, clinical, evolutionary and medico-legal aspects of patients with long bone fractures discharged against medical advice at the Yaoundé Emergency Centre (YEC). This was a retrospective descriptive and analytical study conducted between January 2016 and December 2022 at the YEC. All patients aged 18 years or older with at least one long bone fracture and discharged against medical advice from our study site during the study period were included. Patients were then contacted to collect the reasons for DAMA, the therapeutic itinerary, the type of treatment undertaken, direct costs, and evolutionary data. Statistical analyses were performed using SPSS version 26 software. Six hundred and forty-seven patients were enrolled during the study period, representing a prevalence of DAMA of 45.7%. The mean age of the patients was 35.47 (± 13.86) years, and 475 (73.4%) were men. Socioeconomic status was low in 72.4% of cases. All religions and ethnic groups were represented. Road traffic accidents (RTA) were the cause of trauma in 83% of cases. The main site of injury was the tibia, in 253 (39.1%) cases. Open fractures accounted for 38.8% of cases. The median time to discharge against medical advice was 16 [6-26], , , hours, with 73.4% of DAMA within 24 hours. Lack of financial resources, the choice of traditional treatment and the preference for another hospital were the three main reasons. In our setting, 45.7% of patients with long bone fractures initially admitted to hospital were discharged against medical advice. The type of injury was varied, with 38.8% open fractures, some of which were complex.