Identifying Risk Factors for AMA Discharge After Injury at a Level 1 Trauma Center

Abstract

Background Discharging a patient against medical advice (AMA) is used to describe when a patient opts to leave the hospital prior to a physician’s recommendation while acknowledging the risks of doing so. There are limited published data that identify risk factors for patients leaving AMA, particularly after trauma. Objective This study sought to delineate risk factors for AMA discharge after trauma. Methods Trauma patients who left AMA at our ACS-verified level 1 trauma center were retrospectively included (2021-2022) without exclusions. Demographics, clinical/injury data, and outcomes were collected. The primary outcome was patient-stated reason for leaving AMA. Study variables were summarized with descriptive statistics. Results During the study period, 262 (8%) of 3218 admitted trauma patients left AMA. Psychiatric disease was present in most patients (n = 197, 75%), including substance abuse (n = 146, 56%), and alcohol abuse (n = 95, 36%). Common patient-stated reasons for leaving AMA were inability/unwillingness to wait for procedure, imaging, or placement (n = 56, 22%); and psychiatric disease other than alcohol/substance abuse (n = 39, 15%). Of the patients who left AMA, 29% (n = 77) returned to the hospital 30 days, and 13% (n = 35) were readmitted. Conclusion Patients who leave AMA are at elevated risk of returning to the hospital, which incurs additional costs in already resource-constrained systems. These findings provide impetus for early identification of high-risk patients and efforts to decrease wait times for imaging, procedures, and placement. These actions may mitigate AMA discharges and their resultant impact on patients and hospitals.