SJEMed. 2021; 2(1): 32-41
Prevalence, causes, and predictors of discharge against medical advice (DAMA) in an emergency setting: an updated systematic review and meta-analysis
Authors: Theeb Ayedh Alkahtani, Asaad Shujaa.View PDF HTML Fulltext DOI: 10.24911/SJEMed/72-1588889104
Background: The prevalence of discharge against medical advice (DAMA) ranges from 1% to 2% in inpatient admissions and may reach up to 25.9% in some hospitals. The aim of this meta-analysis was to assess the prevalence, causes, and predictors of DAMA in the emergency departments. Methods: We conducted a systematic electronic database search for suitable studies from inception till 20th January 2020 in nine databases. Meta-analysis was used to pool the results. Results: Of the total 180 records screened, we included 14 studies. The overall prevalence rate of DAMA was 6.3% [95% confidence intervals (CI) = 3.41%-11.63%]. The most common cause of DAMA was not being content with the treatment or not agreeing with the diagnosis/treatment (19.93%; 95% CI = 11.02%-33.34%), followed by long waiting time (8.6%; 95% CI = 0.97%-47.45%) and financial problems (7.15%; 95% CI = 1.45-28.78). Regarding predictors, the reported significant unadjusted predictors were local emergency center [Odds ratios (OR) = 1.23%; 95% CI = 1.21-1.24%; p-value < 0.001], regional emergency center (OR = 0.83%; 95% CI = 0.82%- 0.84%; p-value < 0.001), and non-urgent triage (OR = 12.74%; 95% CI = 1.13%-143.97%; p-value = 0.040). In the same context, the significant adjusted predictors were ≤40 years (males) (OR = 3.94%; 95% CI = 1.31%-11.83%; p-value = 0.014), male gender (youth and middle-aged) (OR = 1.2%; 95% CI = 1.19%-1.21%; p-value < 0.001), and Male gender (aged group) (OR = 1.09%; 95% CI = 1.07%-1.11%; p-value < 0.001). Conclusion: DAMA prevalence in emergency departments is high. More attention should be devoted to those patients in relation to the possible DAMA causes for decreasing negative consequences resulted from committing DAMA.
Keywords: DAMA, emergency, causes, prevalence, predictors
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