ASSESSING VARIOUS FACTORS ASSOCIATED WITH DISCHARGED AGAINST MEDICAL ADVICE, READMISSION AND MORTALITY RATES IN INDIAN CHILD SUBJECTS

Abstract

Background: Owing to the scarce literature data, there is need to assess various factors that correlate to discharge against
medical advice (DAMA) so as to avoid high mortality rate, healthcare costs, morbidity, and readmission rate
Aim: The present study was done to assess various factors associated with discharged against medical advice, readmission
and mortality rates in Indian child subjects.
Methods: The study assessed 1076 child subjects that were in the age range of 6 months to 12 years that reported to the
Institute within the defined study period where DAMA was obtained by 5.2% (n=56) subjects. In all the subjects,
demographic and clinical data were assessed along with the information concerning the reasons for DAMA. Outcome of
DAMA was assessed after 1 month of discharge.
Results: In 56 study subjects that were DAMA at the Institute, predictors assessed included were higher Pediatric Early
Warning Score (PEWS) at admission, underlying chronic disease, and were partial/unimmunized status. The most
commonly identified DAMA contributors were sociodemographic reasons, disease-related reasons, and hospital-related
reasons identified in 25% (n=14), 32.1% (n=18), and 60.7% (n=34) study subjects respectively. A total of 50 subjects
were followed at 1 month where 10 did not survive 20 underwent readmission.
Conclusion: The present study concludes that high rate of mortality and high rate of readmission in child subjects that
attained DAMA focus on the need for the targeted therapies and intervention to assess the underlying causes of discharge
against medical advice.