ArticleBMJ open2023
How does discharge against medical advice affect risk of mortality and unplanned readmission? A retrospective cohort study set in a large UK medical admissions unit.
Article in BMJ open, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed, 13 citations in OpenAlex.
- Spontaneous Rupture of a Peritonsillar Abscess Mimicking Successful Incision and Drainage: A Case Report.Cureus · 2026Article
- Discharge against medical advice among pediatric patients: A retrospective study from a Saudi tertiary emergency department.Saudi medical journal · 2025Article
- Magnitude and associated factors of discharge against medical advice among patients treated in the adult Emergency Department at an Ethiopian University Hospital.African journal of emergency medicine : Revue africaine de la medecine d'urgence · 2025Article
- Burden of multi-drug-resistant organisms in a tertiary healthcare institute in North India: Implications for regional public health.World journal of experimental medicine · 2025Article
- Article
- Understanding the intersections between ethnicity, area-level deprivation, and inpatient-related features amongst patients with psychotic disorders: a mental health electronic records analysis.Social psychiatry and psychiatric epidemiology · 2025Article
- The Unhoused Burn Population: An Alarming Increase of Leaving Against Medical Advice.Journal of burn care & research : official publication of the American Burn Association · 2025Article
- Characteristics and co-morbidities associated with hospital discharges for opioid and methamphetamine co-use, United States 2016-2019.Drug and alcohol dependence reports · 2024Article
- Discharge against medical advice in pediatrics: a 10-year retrospective analysis in a tertiary care center.Annals of Saudi medicineArticle
Corrections and comments
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Authors and funding
5 authors at 3 institutions in 1 country.
Funding
Abstract
objectivesTo assess the frequency of discharge against medical advice (DAMA) in a large UK teaching hospital, explore factors which increase the risk of DAMA and identify how DAMA impacts patient risk of mortality and readmission.
designRetrospective cohort study.
settingLarge acute teaching hospital in the UK. PATIENTS: 36 683 patients discharged from the acute medical unit of a large UK teaching hospital between 1 January 2012 and 31 December 2016. MEASUREMENTS: Patients were censored on 1 January 2021. Mortality and 30-day unplanned readmission rates were assessed. Deprivation, age and sex were taken as covariates.
results3% of patients discharged against medical advice. These patients were younger (median age (years) (IQR)): planned discharge (PD) 59 (40-77); DAMA 39 (28-51), predominantly of male sex (PD 48%; DAMA 66%) and were of greater social deprivation (in three most deprived quintiles PD 69%; DAMA 84%). DAMA was associated with increased risk of death in patients under the age of 33.3 years (adjusted HR 2.6 (1.2-5.8)) and increased incidence of 30-day readmission (standardised incidence ratio 1.9 (1.5-2.2)). LIMITATIONS: Readmission to acute hospitals outside of the local health board may have been missed. We were unable to include information regarding comorbidity or severity of presentation.
conclusionsThese data highlight the vulnerability of younger patients who DAMA, even in a free-at-the-point-of-delivery healthcare setting.
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