The association between acute alcohol consumption and discharge against medical advice of injured patients in the ED

Jeong, Joo; Song, Kyoung Jun; Kim, Yu Jin; Cho, Jin Seong; Park, Ju Ok; Lee, Seung−Chul; Ro, Young Sun; Holmes, James F.

doi:10.1016/j.ajem.2015.11.065

Cited by 21 publications

(11 citation statements)

References 20 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Among 34,000 patients brought by ambulance to an emergency department in a Canadian study, 55% of patients leaving without being seen had a substance abuse diagnosis, compared to 9 % among other patients [7]. A Korean study of 126,000 injury patients found that the risk of discharge against medical advice from the emergency department was nearly doubled when alcohol was involved [8]. In a UK study of patients treated for self-harm in general hospitals, the risk of self-discharge was increased by 49% among those using alcohol or illegal drugs [9].…”

Section: Introductionmentioning

confidence: 99%

Mortality and repeated poisoning after self-discharge during treatment for acute poisoning by substances of abuse: a prospective observational cohort study

et al. 2019

View full text Add to dashboard Cite

BackgroundThough substance use is a known risk factor for self-discharge, patients self-discharging during treatment for acute poisoning have not previously been described. We charted characteristics of patients self-discharging during treatment for acute poisoning by substances of abuse looking for associations between self-discharge, repeated poisoning, and death.MethodsAll patients 12 years and older treated for acute poisoning by substances of abuse at an emergency outpatient clinic in Oslo, Norway, were included consecutively from October 2011 through September 2012. We collected data on gender, age, main toxic agent, suicidal intention, homelessness, history of severe mental illness, and self-discharge. Information on deaths was retrieved from the National Cause of Death Register. We did a multiple logistic regression analysis to look for associations between self-discharge and repeated poisoning and a Cox regression analysis for associations between self-discharge and death.ResultsDuring one year, 1731 patients were treated for 2343 episodes of acute poisoning by substances of abuse. Two-hundred-and-sixty-six (15%) patients self-discharged during at least one poisoning episode. Self-discharging patients were older, median age 39 years vs 32 years (p < 0.001), more frequently homeless, 20/266 (8%) vs 63/1465 (4%) (p = 0.035), and the main toxic agent more frequently was an opioid, 82/266 (31%) vs 282/1465 (19%) (p < 0.001). Self-discharge was an independent risk factor for repeated poisoning. The adjusted odds ratio for two or more poisoning episodes during one year among self-dischargers was 3.0 (95% CI 2.2–4.1). The association was even stronger for three or more poisoning episodes, adjusted odds ratio 5.0 (3.3–7.5). In total, there were 34 deaths, 9/266 (3.4%) among self-discharging patients and 25/1465 (1.7%) among patients not self-discharging (p = 0.12). The adjusted hazard ratio for death among self-discharging patients was 1.6 (0.75–3.6).ConclusionsSelf-discharge was associated with frequent poisonings by substances of abuse. Short-term mortality was doubled among self-discharging patients, though this increase was not statistically significant. Still, the increased risk of repeated poisoning marks self-discharging patients as a vulnerable group who might benefit from targeted post-discharge follow-up measures.

show abstract

Section: Introductionmentioning

confidence: 99%

Mortality and repeated poisoning after self-discharge during treatment for acute poisoning by substances of abuse: a prospective observational cohort study

et al. 2019

View full text Add to dashboard Cite

show abstract

“…9 Several patient factors are associated with higher incidence of leaving against medical advice: male sex, younger age, alcohol use, illicit substance use, weekend treatment, Medicaid insurance, no medical insurance, and treatment on welfare check day. 3,15,16…”

Section: Introductionmentioning

confidence: 99%

Refusal of Emergency Medical Treatment: Case Studies and Ethical Foundations

Marco

Brenner

Kraus

et al. 2017

Annals of Emergency Medicine

View full text Add to dashboard Cite

Informed consent is an important component of emergency medical treatment. Most emergency department patients can provide informed consent for treatment upon arrival. Informed consent should also be obtained for emergency medical interventions that may entail significant risk. A related concept to informed consent is informed refusal of treatment. Patients may refuse emergency medical treatment during their evaluation and treatment. This article addresses important considerations for patients who refuse treatment, including case studies and discussion of definitions, epidemiology, assessment of decisional capacity, information delivery, medicolegal considerations, and alternative care plans.

show abstract

“…[19] In addition, patients who are dependent on drugs and/or alcohol may be more likely to leave the hospital toobtain dependent substances, especially if withdrawal symptoms are not properly treated. [20] The risk of AMA discharge was lower in patients with obesity, acute cardiorespiratory failure, metastatic cancer, solid tumor without metastasis, meningitis, and urinary tract infection or pyelonephritis. We speculate that the associated more severe comorbidities may place a greater burden on sepsis patients and thus in uence their discharge decisions.…”

Section: Discussionmentioning

confidence: 91%

Discharge Against Medical Advice and Risk of Readmission After Sepsis Hospitalization

Lin

Zhai

Han

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: To describe characteristics of sepsis patients who discharged against medical advice (AMA), identify factors associated with AMA discharges in the patients, and evaluate the association of AMA discharge with 30-day unplanned readmission and outcomes of readmission.Methods: Using the National Readmission Database of the United States, we identified inpatients with sepsis who discharged AMA or discharged home between 2010 and 2017. The baseline characteristics were compared between the two groups. Multivariable models were used to identify factors related to AMA discharge, evaluate the association between AMA discharge and 30-day unplanned readmission, and elucidate the relationship between the AMA discharges and in-hospital outcomes.Results: AMA discharges accounted for 2.29% of all the hospitalized sepsis patients. The prevalence of AMA discharge in sepsis patients increased from 1.99% in 2010 to 2.55% in 2014 (p for trend < 0.001).The unplanned 30-day readmission rates of sepsis patients who discharged AMA and who discharged home are 25.51% and 12.26%, respectively. AMA discharge is statistically significantly associated with 30-day [odds ratio (OR), 2.24; 95% confidence interval (CI), 2.15–2.33], 60-day (OR, 2.07; 95% CI, 1.99–2.15), and 90-day (OR, 1.97; 95% CI, 1.90–2.05) readmission. AMA discharge is also associated with longer length of stay in 30 days (0.44 day, 95% CI, 0.12 days-0.76 days, p=0.007), whereas there was no statistically significant difference in hospitalization costs and in-hospital mortality for patients discharged AMA versus those discharged home.Conclusions: Due to the high risk of readmission, vulnerable patients should be early identified. Medical institutions should conduct post-discharge interventions for patients with AMA discharge, such as follow-up visits and psychological counseling, to reduce readmission.

show abstract

The association between acute alcohol consumption and discharge against medical advice of injured patients in the ED

Cited by 21 publications

References 20 publications

Mortality and repeated poisoning after self-discharge during treatment for acute poisoning by substances of abuse: a prospective observational cohort study

Mortality and repeated poisoning after self-discharge during treatment for acute poisoning by substances of abuse: a prospective observational cohort study

Refusal of Emergency Medical Treatment: Case Studies and Ethical Foundations

Discharge Against Medical Advice and Risk of Readmission After Sepsis Hospitalization

Contact Info

Product

Resources

About