Research Reports - Discharge against medical advice in traumatic brain injury: Follow-up and readmission rate

Can J Neurol Sci. 2016 May 26:1-7. [Epub ahead of print]

Marcoux J(1), Alkutbi M(2), Lamoureux J(3), Feyz M(4), Saluja RS(1), de Guise
E(5).

BACKGROUND: Patients who leave hospital against medical advice (AMA) may be at
risk of adverse health outcomes, medical complications, and readmission. In this
study, we examined the characteristics of patients who left AMA after traumatic
brain injury (TBI), their rates of follow-up visits, and readmission.
METHODS: We retrospectively studied 106 consecutive patients who left the
tertiary trauma center AMA (1.8% of all admitted patients with a TBI). Preinjury
health and social issues, mechanism of injury, computed tomography findings, and
injury markers were collected. They were correlated to compliance with follow-up
visits and unplanned emergency room (ER) visits and readmission rates.
RESULTS: The most prevalent premorbid health or social-related issues were
alcohol abuse (33%) and assault as a mechanism of trauma (33%). Only 15 (14.2%)
subjects came to follow-up visit for their TBI. Sixteen (15.1%) of the 106
subjects had multiple readmissions and/or ER visits related to substance abuse.
Seven (6.6%) had multiple readmissions or ER visits with psychiatric reasons.
Those patients with multiple readmissions and ER visits showed in higher
proportion preexisting neurological condition (p=0.027), homelessness (p=0.012),
previous neurosurgery (p=0.014), preexisting encephalomalacia (p=0.011), and had
a higher ISS score (p=0.014) than those who were not readmitted multiple times.
CONCLUSIONS: The significantly increased risks of multiple follow-up visits and
readmission among TBI patients who leave hospital AMA are related to a premorbid
vulnerability and psychosocial issues. Clinicians should target AMA TBI patients
with premorbid vulnerability for discharge transition interventions. 

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