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Citation
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Pierson SB, Dongarwar D, Bini T, Onwukwe JT, House K, Rosiji FO, Salihu HM. J. Am. Acad. Child Adolesc. Psychiatry 2024; ePub(ePub): ePub. |
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Abstract
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OBJECTIVE: Little is known about factors associated with discharge against medical advice in adolescent acute care hospitalization for suicidal ideation (SI) and suicide attempt (SA). Our study seeks to determine if certain socioeconomic factors or hospital characteristics are associated with discharge against medical advice (DAMA) in this population.
METHOD: This retrospective cross-sectional study utilized data from the National Inpatient Sample from the 2015 fourth quarter to 2019. We included children 10 to 19 years of age hospitalized with a primary or secondary International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis of SI or SA. Exposures were patient socio-demographics and hospital characteristics. The outcome was DAMA. Logistic regression generated odds ratios (OR) with 95% confidence intervals (CIs) to measure the association between each patient and hospital characteristics and DAMA.
RESULTS: Of 476,755 hospitalizations meeting inclusion criteria, 3,825 (0.8%) were DAMA. After adjusting for socio-demographics and hospital characteristics, predictive factors for DAMA were age 16-19 years (OR 1.41; CI 1.08-1.82), self-pay status (OR 1.43; CI 1.12-1.83), Hospital Region South and West (OR 1.55; CI 1.10-2.20 and OR 1.79; CI 1.26-2.54, respectively) and urban non-teaching status of the hospital (OR 1.90; CI 1.42-2.55). Hispanic patients were less likely to be DAMA (OR 0.66; CI 0.51-0.85).
CONCLUSION: Variations in DAMA probabilities by age, insurance status, hospital teaching status, and hospital regions suggest a need for a better understanding of this uncommon outcome.
Language: en |