Epidemiological and Clinical Profiles of Patients Leaving Against Medical Advice From the Pediatric Intensive Care Unit of a Tertiary Care Hospital: A Prospective Observational Study

Background Leaving against medical advice (LAMA) in pediatric intensive care units (PICUs) carries substantial risks, yet limited data exist from Indian settings. This study aimed to determine the incidence, demographic and clinical characteristics, and contributory factors for LAMA in a tertiary care PICU. Methods A prospective observational study was conducted at the PICU of King George's Medical University, Lucknow, India, over 12 months. All children aged between one month and 12 years discharged against medical advice (DAMA) were included. Data on demographics, socioeconomic status, diagnosis, reasons for LAMA, and outcomes at 15 days were analyzed using IBM SPSS Statistics, version 23.0 (IBM Corp., Armonk, NY). Results Of 932 admissions, 135 (14.5%) left against medical advice. Among these patients, the mean age was 62.8 months; most were male, 76 (56.3%), and from rural areas, 78 (57.8%), and a total of 31 (23.0%) belonged to the lower socioeconomic class. The main reasons cited for LAMA were perceived poor survival, 85 (63.0%), and financial burden, 58 (43.0%). Parental illiteracy was reported in 27 (29.7%), and low income also showed significant associations for mortality among patients who left against medical advice. Conclusion LAMA rates in this PICU were high, predominantly driven by socioeconomic hardship and pessimism regarding prognosis. Interventions combining financial assistance, strengthened caregiver communication, and structured support services may help reduce LAMA and improve outcomes in critically ill children.