Saudi Journal of Emergency Medicine

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Original Article
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

Abstract

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


© Copyright: Author(s)

Open access Creative Commons License
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
Bioethicist, Potion CRO, Integrative Medicine Company, Riyadh, Kingdom of Saudi Arabia
PubMed articlesGoogle scholar articles

Asaad Shujaa
Lead of Research at Johns Hopkins Aramco Health Care Centre, Consultant of Emergency Medicine, ICU, Trauma, EMS and Disaster Medicine, Johns Hopkins Aramco Health Care Centre, Saudi Arabia Assistant Professor at Weill Cornell Medical College, USA
PubMed articlesGoogle scholar articles


Correspondence to:
. Theeb Ayedh Alkahtani, Integrative Medicine Company, Riyadh, Kingdom of Saudi Arabia.; theeb@integrativemed.co

Publication history
Received 07 May 2020
Accepted 09 Nov 2020
Published online 04 Jan 2021
Published in print 21 Jan 2021

How to cite this article

Pubmed Style

Alkahtani TA, Shujaa A. Prevalence, causes, and predictors of discharge against medical advice (DAMA) in an emergency setting: an updated systematic review and meta-analysis. SJEMed. 2021; 2(1): 32-41. doi:10.24911/SJEMed/72-1588889104


Web Style

Alkahtani TA, Shujaa A. Prevalence, causes, and predictors of discharge against medical advice (DAMA) in an emergency setting: an updated systematic review and meta-analysis. https://www.sjemed.com/?mno=105460 [Access: February 08, 2023]. doi:10.24911/SJEMed/72-1588889104


AMA (American Medical Association) Style

Alkahtani TA, Shujaa A. Prevalence, causes, and predictors of discharge against medical advice (DAMA) in an emergency setting: an updated systematic review and meta-analysis. SJEMed. 2021; 2(1): 32-41. doi:10.24911/SJEMed/72-1588889104


Vancouver/ICMJE Style

Alkahtani TA, Shujaa A. Prevalence, causes, and predictors of discharge against medical advice (DAMA) in an emergency setting: an updated systematic review and meta-analysis. SJEMed. (2021), [cited February 08, 2023]; 2(1): 32-41. doi:10.24911/SJEMed/72-1588889104


Harvard Style

Alkahtani, T. A. & Shujaa, . A. (2021) Prevalence, causes, and predictors of discharge against medical advice (DAMA) in an emergency setting: an updated systematic review and meta-analysis. SJEMed, 2 (1), 32-41. doi:10.24911/SJEMed/72-1588889104


Turabian Style

Alkahtani, Theeb Ayedh, and Asaad Shujaa. 2021. Prevalence, causes, and predictors of discharge against medical advice (DAMA) in an emergency setting: an updated systematic review and meta-analysis. Saudi Journal of Emergency Medicine, 2 (1), 32-41. doi:10.24911/SJEMed/72-1588889104


Chicago Style

Alkahtani, Theeb Ayedh, and Asaad Shujaa. "Prevalence, causes, and predictors of discharge against medical advice (DAMA) in an emergency setting: an updated systematic review and meta-analysis." Saudi Journal of Emergency Medicine 2 (2021), 32-41. doi:10.24911/SJEMed/72-1588889104


MLA (The Modern Language Association) Style

Alkahtani, Theeb Ayedh, and Asaad Shujaa. "Prevalence, causes, and predictors of discharge against medical advice (DAMA) in an emergency setting: an updated systematic review and meta-analysis." Saudi Journal of Emergency Medicine 2.1 (2021), 32-41. Print. doi:10.24911/SJEMed/72-1588889104


APA (American Psychological Association) Style

Alkahtani, T. A. & Shujaa, . A. (2021) Prevalence, causes, and predictors of discharge against medical advice (DAMA) in an emergency setting: an updated systematic review and meta-analysis. Saudi Journal of Emergency Medicine, 2 (1), 32-41. doi:10.24911/SJEMed/72-1588889104


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