Impact of discharge against medical advice on emergency department revisits and prognosis among pneumonia patients recommended to be hospitalized in a general ward

Seo, Myung Ha; Sung, Won Young; Lee, Jang Young; Lee, Won Suk; Seo, Sang Won; Lee, Keun Taek

J Korean Soc Emerg Med > Volume 33(2); 2022 > Article

Original Article

Journal of The Korean Society of Emergency Medicine 2022;33(2): 172-183.

응급실에서 일반병실로 입원 권고를 받은 폐렴 환자에서 자의 퇴원이 응급실 재방문 및 예후에 미치는 영향

서명하

대전을지대학교병원 응급의학과

Impact of discharge against medical advice on emergency department revisits and prognosis among pneumonia patients recommended to be hospitalized in a general ward

Department of Emergency Medicine, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Korea

Correspondence

Won Young Sung ,Tel: 042-611-3256, Fax: 042-611-3880, Email: sage77@hanmail.net,

Received: June 28, 2021; Revised: September 24, 2021 Accepted: September 29, 2021. Published online: April 30, 2022.

ABSTRACT

Objective:
This study examined the clinical consequences of a discharge against medical advice (DAMA) among pneumonia patients recommended to be hospitalized in a general ward and identified the risk factors related to a revisit after DAMA.
Method:
This retrospective observational study included pneumonia patients who presented at a university hospital emergency department (ED) and were recommended to be hospitalized in a general ward between January 2017 and December 2019. A multivariate logistic regression analysis was performed to identify the risk factors related to a revisit after DAMA and mortality.
Results:
In the ‘revisit after DAMA’ group, the mortality rate was higher than the ‘no DAMA admission’ group (6.9% vs. 2.1%, P=0.009). Among all admitted patients, DAMA was a risk factor for mortality (odds ratio [OR], 6.185; P=0.023). In the ‘revisit after DAMA’ group, sex (OR, 6.590; P=0.005), C-reactive protein (CRP) score (OR, 1.149; P=0.022), febrile symptoms (OR, 6.569; P=0.004), and dyspnea (OR, 5.480; P=0.002) were risk factors of revisit. Furthermore, in the ‘revisit after DAMA’ group, the CRP score of the 2nd ED visit was higher than that of the 1st ED visit (6.55±6.27 vs. 8.20±7.31, P=0.014).
Conclusion:
This study shows that DAMA is one of the risk factors for mortality. When DAMA patients revisit, the severity of their pneumonia was observed to have increased.

Key words: Pneumonia; Emergency department; Mortality