Factors affecting discharge against medical advice (DAMA) at a private level 1 trauma centre: A retrospective cohort study

Background & objectives Discharge Against Medical Advice (DAMA) is a global healthcare challenge. This study was undertaken to understand the factors affecting DAMA among adult trauma patients at a level 1 private trauma centre. Methods This retrospective cohort study was conducted with the data collected for all adult trauma patients attending the Emergency department of Christian Medical College, Vellore, Tamil Nadu. DAMA patients were compared to those who completed their treatment. Socio-economic status of DAMA patients, the predominant reasons for DAMA and their outcome at six months were analysed. Logistic regression was done to identify factors predicting DAMA. Results Of the 2486 individuals enrolled, the number of DAMA patients was 174 (6.9%). DAMA patients had a lower mean GCS (11.8±5.0 vs. 14.3±2.4) and higher median ISS [9, interquartile range (IQR) 4-13 vs. 4, IQR 3-9]. The main reason for DAMA was financial constraints (42.5%). Furthermore, 52.8 per cent of the DAMA patients belonged to the upper-lower class. Logistic regression revealed three variables that increased the odds of DAMA namely, GCS <15 [odds ratio (OR) 2.6], TBI (OR 1.99), and vertebral fractures/spinal cord injury (OR 2.82). Interpretation & conclusions The findings of this study suggest that poor patients and patients from low SES were often unable to afford comprehensive trauma care at private trauma centres, with a majority of these individuals having TBI.