Characteristics of patients with acute traumatic brain injury discharged against medical advice in a Level 1 urban trauma centre

Abstract

Primary objective: To predict which characteristics are associated with patients at risk of discharge against medical advice (AMA).

Research design: Data were retrospectively collected on individuals (n = 5642) admitted to the Traumatic Brain Injury Program of the MUHC-MGH.

Methods and procedures: Outcome measures used were length of stay (LOS), the Extended Glasgow Outcome Scale (GOSE) as well as the Functional Independence Measure (FIM®).

Main outcomes: The overall rate of patients leaving AMA was 1.9% (n = 108). Age was negatively associated with AMA discharge (95% CI OR = [0.966;0.991]). Patients with a history of substance abuse were ∼2-times more likely to leave AMA than those not using substances before injury (95% CI OR = [1.172;3.314]) and the homeless were ∼3-times more likely to leave AMA compared to those who were not homeless (95% CI OR = [1.260;7.138]). Length of stay (LOS) was shorter for patients leaving AMA (p < 0.001) and they showed better outcome (GOSE: p < 0.001; FIM®: p = 0.032).

Conclusions: Knowing the profile of patients with TBI leaving AMA hospitalized in an urban Level 1 Trauma centre will help in the development of effective strategies based on patient needs, values and pre-injury psychosocial situation to encourage them to complete their treatment course in hospital.

• Discharge against medical advice
• Level 1 trauma centre
• outcome
• traumatic brain injury

Acknowledgements

The service marks and trade-marks associated with the FIM® instrument are all owned by Uniform Data System for Medical Rehabilitation, a division of UB Foundation Activities, Inc. Use herein of service marks and trade-marks associated with the FIM® instrument is made with the permission of the Uniform Data System for Medical Rehabilitation. The use of the FIM® instrument to collect patient data discussed or otherwise dealt with in this publication was authorized and conducted in accordance with the terms of a special purpose license granted to Licensee by the Canadian Institute for Health Information (‘CIHI’). The patient data collected has not been processed by CIHI or Uniform Data System for Medical Rehabilitation (‘UDSMR’). No implication is intended that such data has been or will be subjected to CIHI or UDSMR’s standard data processing procedures or that it is otherwise comparable to data processed by CIHI or UDSMR.