Children Discharged Against Medical Advice and Their Outcome in a Public Hospital in India: A Prospective Cohort Study.

IF 1.7 4区医学 Q2 PEDIATRICS

Indian pediatrics Pub Date : 2025-06-04 DOI:10.1007/s13312-025-00108-3

Shilpi Jha, Devendra Mishra, Anurag Agarwal

{"title":"Children Discharged Against Medical Advice and Their Outcome in a Public Hospital in India: A Prospective Cohort Study.","authors":"Shilpi Jha, Devendra Mishra, Anurag Agarwal","doi":"10.1007/s13312-025-00108-3","DOIUrl":null,"url":null,"abstract":"Objectives: To determine the factors associated with discharge against medical advice (DAMA), and the readmission and mortality rate at one-month follow-up among these children.Methodology: This prospective cohort study enrolled consecutive children (6 months-12 years) from one designated inpatient ward. Clinical and demographic data, and information about reasons for DAMA were collected using a structured interview. Outcome of DAMA patients was assessed telephonically at one month after discharge.Results: Out of 538 children, 28 (5.2%) obtained DAMA. Predictors of DAMA on multivariate analysis were partial/unimmunized status, underlying chronic disease, and higher Pediatric Early Warning Score (PEWS) at admission. The most common contributors to DAMA included hospital-related reasons (n = 17, 60.7%), disease-related reasons (n = 9, 32.1%), and sociodemographic reasons (n = 7, 25%). A total of 25 children could be followed up at one month; of these 10 were readmitted at another hospital, and 5 died.Conclusions: The high rates of readmission and mortality among these children emphasize the need for targeted interventions to address the underlying causes of DAMA.","PeriodicalId":13291,"journal":{"name":"Indian pediatrics","volume":" ","pages":""},"PeriodicalIF":1.7000,"publicationDate":"2025-06-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Indian pediatrics","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s13312-025-00108-3","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PEDIATRICS","Score":null,"Total":0}

引用次数: 0

Abstract

Objectives: To determine the factors associated with discharge against medical advice (DAMA), and the readmission and mortality rate at one-month follow-up among these children.

Methodology: This prospective cohort study enrolled consecutive children (6 months-12 years) from one designated inpatient ward. Clinical and demographic data, and information about reasons for DAMA were collected using a structured interview. Outcome of DAMA patients was assessed telephonically at one month after discharge.

Results: Out of 538 children, 28 (5.2%) obtained DAMA. Predictors of DAMA on multivariate analysis were partial/unimmunized status, underlying chronic disease, and higher Pediatric Early Warning Score (PEWS) at admission. The most common contributors to DAMA included hospital-related reasons (n = 17, 60.7%), disease-related reasons (n = 9, 32.1%), and sociodemographic reasons (n = 7, 25%). A total of 25 children could be followed up at one month; of these 10 were readmitted at another hospital, and 5 died.

Conclusions: The high rates of readmission and mortality among these children emphasize the need for targeted interventions to address the underlying causes of DAMA.

查看原文本刊更多论文

印度一家公立医院不遵医嘱出院的儿童及其预后：一项前瞻性队列研究

目的：确定与不遵医嘱出院（DAMA）相关的因素，以及这些儿童一个月随访时的再入院率和死亡率。方法：这项前瞻性队列研究招募了来自指定住院病房的连续儿童（6个月至12岁）。临床和人口统计数据，以及DAMA的原因信息是通过结构化访谈收集的。出院后1个月电话评估DAMA患者的预后。结果：538例患儿中，28例（5.2%）获得DAMA。在多变量分析中，DAMA的预测因子为部分/未免疫状态、潜在慢性疾病和入院时较高的儿科早期预警评分（PEWS）。导致DAMA最常见的原因包括医院相关原因（n = 17, 60.7%）、疾病相关原因（n = 9, 32.1%）和社会人口统计学原因（n = 7, 25%）。1个月随访25名儿童；其中10人在另一家医院再次入院，5人死亡。结论：这些儿童的高再入院率和死亡率强调需要有针对性的干预措施来解决DAMA的根本原因。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Indian pediatrics 医学-小儿科

CiteScore

3.30

自引率

8.70%

发文量

344

审稿时长

3-8 weeks

期刊介绍： The general objective of Indian Pediatrics is "To promote the science and practice of Pediatrics." An important guiding principle has been the simultaneous need to inform, educate and entertain the target audience. The specific key objectives are: -To publish original, relevant, well researched peer reviewed articles on issues related to child health. -To provide continuing education to support informed clinical decisions and research. -To foster responsible and balanced debate on controversial issues that affect child health, including non-clinical areas such as medical education, ethics, law, environment and economics. -To achieve the highest level of ethical medical journalism and to produce a publication that is timely, credible and enjoyable to read.