Characteristics of patients with acute traumatic brain injury discharged against medical advice in a Level 1 urban trauma centre. (September 2014)

• Record Type: Journal Article
• Authors: de Guise, Elaine; LeBlanc, Joanne; Dagher, Jehane; Tinawi, Simon; Lamoureux, Julie; Marcoux, Judith; Maleki, Mohammed; Feyz, Mitra
• Is Part Of: Brain injury. Volume 28:Number 10(2014)
• Page Start: 1288
• Page End: 1294
• Publication Date: 2014-09
• Subjects: Brain damage -- Periodicals; Brain -- Wounds and injuries -- Periodicals; Brain Injuries -- Periodicals; 617.481
• DOI: 10.3109/02699052.2014.916820
• Languages: English
• ISSNs: 0269-9052

Abstract

<abstract> <title>Abstract</title> <p> <italic>Primary objective</italic>: To predict which characteristics are associated with patients at risk of discharge against medical advice (AMA).</p> <p> <italic>Research design</italic>: Data were retrospectively collected on individuals (<italic>n</italic> = 5642) admitted to the Traumatic Brain Injury Program of the MUHC-MGH.</p> <p> <italic>Methods and procedures</italic>: Outcome measures used were length of stay (LOS), the Extended Glasgow Outcome Scale (GOSE) as well as the Functional Independence Measure (FIM®).</p> <p> <italic>Main outcomes</italic>: The overall rate of patients leaving AMA was 1.9% (<italic>n</italic> = 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 (<italic>p</italic> < 0.001) and they showed better outcome (GOSE: <italic>p</italic> < 0.001; FIM®: <italic>p</italic> = 0.032).</p> <p> <italic>Conclusions</italic>: 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.</p> </abstract>