Profile and Outcome of DAMA among Paediatric Patients from a Tertiary Care Centre of a Non Profit Private Teaching Institute at Gujarat, India

Abstract

Introduction: The problem of Discharge Against Medical Advice (DAMA) has been reported globally, including in patients of the paediatric age group. Even the Indian subcontinent faces such problems, whether, it is the private sector or public sector. Terminal illness, low affordability, social reason are a few of the common reasons for this DAMA problem. Aim: To know the outcome and demographic profile of DAMAs among paediatric patients at a tertiary care teaching institute. Materials and Methods: This mix-method, prospective descriptive study was conducted in Department of Paediatrics, Pramukhswami Medical College and Shree Krishna Hospital, Karamsad, Gujarat, India, from March 2020 to February 2021. Contact details of patients, whose parents took DAMA from the hospital, were retrieved from the Electronic Health Record system. Interviews were recorded and the required information was gathered. Median (interquartile range), frequency, percentage and proportion of age, sex, diagnosis, and reasons of DAMAs derived. Results: Out of a total of 1752 registered paediatric patients (1 month to 18 years), 74 patients were given DAMA, of which 42 consented to interview. The mean age was 70.36±67.9 months and 65% were males. Amongst these 42, 31(73.81%) were taken to home and 11 (26.19%) to another hospital; 20 (47.62%) patients died. Among the rest, 6 (14.28%) had morbidity. Total deaths were 20, out of which six died within one hour, another four died within 24 hours, two died within 7 days and rest eight were died any time after 7 days till contacted. Family or social reason was the top cause of DAMA, whereas, poor prognosis with or without affordability issues was next. Among all diagnoses, nearly half of the cases were infectious/ inflammatory, 10% tumour/malignancy, and 6.14% trauma/ head injuries. Conclusion: DAMA rate was not high in this study. But this was not preventable in majority of the cases as poor prognosis as well as family or social reasons were the major causes of DAMA.