Factors Influencing Discharge Against Medical Advice Among Patients with Neurotrauma

Introduction: Injuries to the cranium and spine pose significant risks of severe morbidity and mortality, especially when patients opt to leave against medical advice (LAMA). These decisions can impede recovery and lead to adverse health outcomes. This study aims to identify characteristics of patients with non-accidental traumatic craniospinal injuries who left AMA.

Methods: The National Inpatient Sample was analyzed to identify patients with non-accidental traumatic craniospinal injuries who left AMA. Patient demographics, hospital characteristics, and clinical factors were examined as potential contributors to patients leaving AMA.

Results: Among the 11,457 patients identified with non-accidental traumatic craniospinal injuries, 537 (4.7%) left AMA. LAMA patients were predominantly male (87.3%, p=0.032) and from central metropolitan areas (50.9%, p< 0.001). There were no significant differences in racial or income quartile distributions between patients who left AMA and those who did not. Notably, 65.7% of LAMA patients had Medicaid or Medicare, while 9.9% had private insurance. Geographic differences were evident, with hospitals in the West and South reporting higher rates of LAMA patients (32.8% and 25.7%, respectively), while hospitals in the Midwest had lower rates (18.2%). Most patients leaving AMA received care at private not-for-profit hospitals (63.1%) and at hospitals with large bedsizes (60.3%). The majority of injuries resulted from physical altercations (45.8%), and this group was also more likely to leave AMA (p < 0.001).

Conclusion : This study highlights that demographic and hospital-related factors such as male gender, Medicaid insurance, and receiving care at private not-for-profit hospitals in the West and South were associated with leaving AMA. Understanding these factors can aid in the development of strategies to reduce the rates at which patients leave AMA and thereby improve patient outcomes.