Mariano E. Menendez|Niek C. van Dijk|David Ring
Who Leaves the Hospital Against Medical Advice in the Orthopaedic Setting?
Massachusetts General Hospital|Academic Medical Center|Massachusetts General Hospital
patients leave hospital medical advice risk readmission variety complications likely consume healthcare resources however little known factors may associated selfdischarge discharge medical advice among orthopaedic inpatientswe studied frequency factors associated selfdischarge patients hospitalized orthopaedic trauma musculoskeletal infectionusing discharge records nationwide inpatient sample 20022011 identified approximately 7067432 patient hospitalizations orthopaedic trauma 5488686 musculoskeletal infection calculated proportions admissions ended selfdischarge trauma infection patients examined patient demographics diagnoses hospital factors multivariable logistic regression models constructed determine independent predictors selfdischargeapproximately one 333 03 patients hospitalized isolated fracture one 47 21 patients musculoskeletal infection left medical advice patient characteristics associated selfdischarge included age 75 years trauma odds ratio 27 95 confidence interval ci 2528 p 0001 infection 39 95 ci 3841 p 0001 male sex trauma 17 95 ci 1718 p 0001 infection 14 95 ci 1314 p 0001 black raceethnicity trauma 15 95 ci 1416 p 0001 infection 11 95 ci 1111 p 0001 low household income trauma 15 95 ci 1415 p 0001 infection 14 95 ci 1414 p 0001 nonprivate insurance medicare trauma 17 95 ci 1618 p 0001 infection 25 95 ci 2425 p 0001 medicaid trauma 26 95 ci 2527 p 0001 infection 32 95 ci 3233 p 0001 insurance coverage trauma 30 95 ci 2931 p 0001 infection 35 95 ci 3435 p 0001 less medical comorbidity trauma 094 per oneunit increase number comorbidities 95 ci 093095 p 0001 infection 088 95 ci 087088 p 0001 alcohol trauma 23 95 2224 p 0001 infection 15 95 ci 1515 p 0001 opioid trauma 29 95 ci 2731 p 0001 infection 44 95 ci 4344 p 0001 nonopioid drug abuse trauma 20 95 ci 1921 p 0001 infection 28 95 ci 2829 p 0001 psychosis trauma 13 95ci 1213 p 0001 infection 13 95 ci 13 14 p 0001 aidshiv infection trauma 15 95 ci 1218 p 0001 infection 13 95 ci 1314 p 0001 patients upper extremity fractures 19 95 ci 1819 p 0001 fractures neck trunk 21 95 ci 2022 p 0001 likely leave medical advice patients lower extremity fractures among infection hospitalizations patients cellulitis highest odds selfdischarge compared carbunclefuruncle 13 95 ci 1215 p 0001 selfdischarges likely occur hospitals larger size trauma 12 95 ci 1112 p 0001 infection nonsignificant located urban settings trauma 13 95 ci 1214 p 0001 infection 16 95 ci 1516 p 0001 northeast trauma 17 95 ci 1618 p 0001 infection 16 95 ci 1616 p 0001 small rural hospitals southour data used promptly identify orthopaedic inpatients higher risk selfdischarge admission target interventions optimize treatment adherence strategies enhance physician communication skills among patients low health literacy improve cultural sensitivity proactively address substance abuse issues early hospital admission may aid preventing discharge dilemmas merit additional studylevel iii prognostic study see instructions authors complete description levels evidence